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Full text of "Report of the Secretary's Task Force on Black and Minority Health: Volume VIII: Hispanic Health/Inventory/Survey"

Volume VIII: 
Hispanic Health Issues 

Inventory of 
DHHS Programs 

Survey of Non-Federal 
Community 



Report of the 
Secretary's Task 
Force on 






Black & 

Minority 

Health 



U.S. Department of Health and 
Human Services 



tt HiOJ> Woi- 



Volume VIII: 
Hispanic Health Issues 

Inventory of 
DHHS Programs 

Survey of Non-Federal 
Community 



Report of the 
Secretary's Task 
Force on 



Black & 

Minority 

Health 



U.S. Department of Health and 
Human Services 

January 1986 



SECRETARY'S TASK FORCE ON BLACK AND MINORITY HEALTH 



MEMBERS 



Thomas E. Malone, Ph.D., Chairperson 
Katrina W. Johnson, Ph.D., Study Director 



Wendy Baldwin, Ph.D 

Betty Lou Dotson, J.D. 

Manning Feinleib, M.D., Dr.P.H. 

William T. Friedewald, M.D. 

Robert Graham, M.D. 

M. Gene Handelsraan 

Jane E. Henney, M.D. 

Donald R. Hopkins, M.D. 

Stephanie Lee-Miller 



Jaime Manzano 

J. Michael McGinnis, M.D. 

Mark Novitch, M.D. 

Clarice D. Reid, M.D. 

Everett R. Rhoades , M.D. 

William A. Robinson, M.D.j 

James L. Scott 

Robert L. Trachtenberg 

T. Franklin Williams, M.D. 



M.P.H. 



ALTERNATES 



Shirley P. Bagley, M.S. 
Claudia Baquet, M.D., M.P.H. 
Howard M. Bennett 
Cheryl Damberg, M.P.H. 
Mary Ann Danello, Ph.D. 
Jacob Feldman, Ph.D. 
Marilyn Gaston, M.D. 
George Hardy, M.D. 
John H. Kelso 



James A. Kissko 
Robert C. Kreuzburg, M.D. 
Barbara J. Lake 
Patricia L. Mackey, J.D. 
Delores Parron, Ph.D. 
Gerald H. Payne, M.D. 
Caroline I. Reuter 
Clay Simpson, Jr., Ph.D. 
Ronald J. Wylie 



VOLUME VIII 
TABLE OF CONTENTS 

Introduction to the Task Force Report v 

HISPANIC HEALTH ISSUES 

Hispanic Advisory Group ........... 1 

Introduction to Hispanic Health Issues ....... 3 

Sylvia F. Villarreal: Current Issues in Hispanic Health . . 11 

Fernando Trevino: National Statistical Data Systems and 

the Hispanic Population . 45 

Henrietta Villaescusa, Editor: Selected Hispanic Health 

Issues of the Eighties — An Annotated Bibliography .... 55 

INVENTORY OF DHHS PROGRAM EFFORTS IN MINORITY HEALTH .... 243 

i 

SURVEY OF THE NON-FEDERAL COMMUNITY 381 



IV 



INTRODUCTION TO THE TASK FORCE REPORT 

Ba ckgroun d 

The Task Force on Black and Minority Health was established by 
Secretary of Health and Human Services Margaret M. Heckler in response 
to the striking differences in health status between many minority 
populations in the United States and the nonminority population. 

In January 1984, when Secretary Heckler released the annual report 
of the Nation's health, Health, United States, 1983 , she noted that the 
health and longevity of all Americans have continued to improve, but the 
prospects for living full and healthy lives were not shared equally by 
many minority Americans. Mrs. Heckler called attention to the longstanding 
and persistent burden of death, disease, and disability experienced by 
those of Black, Hispanic, Native American, and Asian/Pacific Islander 
heritage in the United States. Among the most striking differentials 
are the gap of more than 5 years in life expectancy between Blacks and 
Whites and the infant mortality rate, which for Blacks has continued to 
be twice that of Whites. While the differences are particularly evident 
for Blacks, a group for whom information is most accurate, they are 
clear for Hispanics, Native Americans, and some groups of Asian/Pacific 
Islanders as well. 

By creating a special Secretarial Task Force to investigate this 
grave health discrepancy and by establishing an Office of Minority Health 
to implement the recommendations of the Task Force, Secretary Heckler 
has taken significant measures toward developing a coordinated strategy 
to improve the health status of all minority groups. 

Dr. Thomas E. Malone, Deputy Director of the National Institutes of 
Health, was appointed to head the Task Force and 18 senior DHHS executives 
whose programs affect minority health were selected to serve as primary 
members of the Task Force. While many DHHS programs significantly benefit 
minority groups, the formation of this Task Force was unique in that it 
was the first time that attention was given to an integrated, comprehensive 
study of minority health concerns. 

Charge 

Secretary Heckler charged the Task Force with the following duties: 

• Study the current health status of Blacks, Hispanics, Native 
Americans, and Asian/Pacific Islanders. 

• Review their ability to gain access to and utilize the health 
care system. 

• Assess factors contributing to the long-term disparities in 
health status between the minority and nonminority populations. 



• Review existing DHHS research and service programs relative to 
minority health. 

• Recommend strategies to redirect Federal resources and programs to 
narrow the health differences between minorities and nonminorities. 

• Suggest strategies by which the public and private sectors can 
cooperate to bring about improvements in minority health. 

Approach 

After initial review of national data, the Task Force adopted a 
study approach based on the statistical technique of "excess deaths" 
to define the differences in minority health in relation to nonminority 
health. This method dramatically demonstrated the number of deaths among 
minorities that would not have occurred had mortality rates for minorities 
equalled those of nonminorities. The analysis of excess deaths revealed 
that six specific health areas accounted for more than 80 percent of the 
higher annual proportion of minority deaths. These areas are: 

• Cardiovascular and cerebrovascular diseases 

• Cancer 

• Chemical dependency 

• Diabetes 

• Homicide, suicide, and unintentional injuries 

• Infant mortality and low birthweight. 

Subcommittees were formed to explore why and to what extent these 
health differences occur and what DHHS can do to reduce the disparity. 
The subcommittees examined the most recent scientific data available 
in their specific areas and the physiological, cultural, and societal 
factors that might contribute to health problems in minority populations. 

The Task Force also investigated a number of issues that cut across 
specific health problem areas yet influence the overall health status of 
minority groups. Among those reviewed were demographic and social 
characteristics of Blacks, Hispanics, Native Americans, and Asian/Pacific 
Islanders; minority needs in health information and education; access to 
health care services by minorities; and an assessment of health professionals 
available to minority populations. Special analyses of mortality and 
morbidity data relevant to minority health also were developed for the 
use of Task Force. Reports on these issues appear in Volume IT. 

Resources 



More than 40 scientific papers were commissioned to provide recent 
data and supplementary information to the Task Force and its subcommittees, 
Much material from the commissioned papers was incorporated into the 
subcommittee reports; others accompany the full text of the subcommittee 
reports . 



VI 



An inventory of DHHS program efforts in minority health was compiled 
by the Task Force. It includes descriptions of health care, prevention, 
and research programs sponsored by DHHS that affect minority populations. 
This is the first such compilation demonstrating the extensive efforts 
oriented toward minority health within DHHS. An index listing agencies 
and program titles appears in Volume I. Volume VIII contains more 
detailed program descriptions as well as telephone numbers of the offices 
responsible for the administration of these programs. 

To supplement its knowledge of minority health issues, the Task 
Force communicated with individuals and organizations outside the Federal 
system. Experts in special problem areas such as data analysis, nutrition, 
or intervention activities presented up-to-date information to the Task 
Force or the subcommittees. An Hispanic consultant group provided inform- 
ation on health issues affecting Hispanics. A summary of Hispanic health 
concerns appears in Volume VIII along with an annotated bibliography of 
selected Hispanic health issues. Papers developed by an Asian/Pacific 
Islander consultant group accompany the data development report appearing 
in Volume II. 

A nationwide survey of organizations and individuals concerned with 
minority health issues was conducted. The survey requested opinions 
about factors influencing health status of minorities, examples of success- 
ful programs and suggestions for ways DHHS might better address minority 
health needs. A summary of responses and a complete listing of the 
organizations participating in the survey is included in Volume VIII. 

Task Force Report 

Volume I, the Executive Summary, includes recommendations for 
department-wide activities to improve minority health status. The 
recommendations emphasize activities through which DHHS might redirect 
its resources toward narrowing the disparity between minorities and 
nonminorities and suggest opportunities for cooperation with nonfederal 
structures to bring about improvements in minority health. Volume I 
also contains summaries of the information and data compiled by the Task 
Force to account for the health status disparity. 

Volumes II through VIII contain the complete text of the reports 
prepared by subcommittees and working groups. They provide extensive 
background information and data analyses that support the findings and 
intervention strategies proposed by the subcommittees. The reports are 
excellent reviews of research and should be regarded as state-of-the-art 
knowledge on problem areas in minority health. Many of the papers commissioned 
by the Task Force subcommittees accompany the subcommittee report. They 
should be extremely useful to those who wish to become familiar in greater 
depth with selected aspects of the issues that the Task Force analyzed. 



vn 



The full Task Force report consists of the following volumes: 

Volume I: Executive Summary 

Volume II: Crosscutting Issues in Minority Health: 

Perspectives on National Health Data for Minorities 
Minority Access to Health Care 
Health Education and Information 

Minority and other Health Professionals Serving Minority 
Communities 

Volume III: Cancer 

Volume IV: Cardiovascular and Cerebrovascular Diseases 

Volume V: Homicide, Suicide, and Unintentional Injuries 

Volume VI: Infant Mortality and Low Birthweight 

Volume VII: Chemical Dependency 
Diabetes 

Volume VIII: Hispanic Health Issues 

Survey of the Non-Federal Community 

Inventory of DHHS Program Efforts in Minority Health 



vm 



HISPANIC HEALTH ISSUES 



HISPANIC ADVISORY GROUP 



Jane Delgado, Ph.D. 

Special Assistant on Minority Affairs 
Office of the Secretary- 
Washington, D.C. 

Lillian Comas-Diaz 

American Psychological Association 

Washington, D.C. 

Jaime Manzano 

Formerly: Deputy Assistant Secretary 
Office of Human Development Services 
Washington, D.C. 

Magdalena Miranda 

International Medical Education Programs Branch 

Bureau of Health Professions 

Health Resources and Services Administration 

Rockville, Maryland 

Manuel Miranda, Ph.D. 

Visiting Scientist 

National Institute of Mental Health 

Rockville, Maryland 

Henry Montes 

Office of Disease Prevention and Health Promotion 

Washington, D.C. 

Jose de la Puente 

American Public Health Association 

Washington, D.C. 

Task Force liaison: 

Marta Sotomayor, Ph.D. 

Senior Policy Analyst 

Task Force on Black and Minority Health 



INTRODUCTION TO HISPANIC HEALTH ISSUES 



Presenting an accurate picture of the health status and needs of 
Hispanic Americans offers a difficult and complex challenge. National 
data on the health status of Hispanics in the United States are sparse. 
With the exception of the Hispanic Health and Nutrition Examination 
Survey (HHANES) , few, if any, reports address Hispanic health issues from 
a national perspective. Thus, there is a gap in information that prevents 
policy makers, planners, and administrators from identifying appropriate 
interventions to promote the well-being of many sectors of the Hispanic 
population in the United States. 

Hispanic Advisory Group 

To provide more information about the health problems of the Hispanic 
community, the Task Force on Black and Minority Health worked with several 
distinguished consultants outside the Federal government and a group of 
scientific advisors within DHHS who have been active in promoting Hispanic 
issues in the Department. These individuals were designated the Hispanic 
Advisory Group. Its tasks were to identify the most pressing health 
problems faced by Hispanics, to provide the Task Force members with some 
perspectives and insights into Hispanic health problems, and to suggest 
activities that could be implemented within the constraints under which 
the Task Force operated. The long-term goal of this effort is improved 
health and health services for Hispanics. 

Activities of the Hispanic Advisory Group 

The Hispanic Advisory Group met to discuss a number of problems they 
identified as critical to Hispanic health. Three non-Federal scientific 
consultants — Dr. Sylvia Villarreal, Ms. Henrietta Villaescusa, and Dr. 
Fernando Trevino — were invited to present their analyses of selected 
Hispanic health issues to the Task Force. Their topics included an 
overview of Hispanic history and demographics, current issues in Hispanic 
health, and national statistical data systems that relate to Hispanic 
populations. These presentations are summarized in this volume. 

An annotated bibliography of selected research topics in Hispanic 
health, commissioned as a separate activity of the advisory group, 
also appears in this volume. 

Each of the Task Force subcommittees also obtained information 
from other experts in Hispanic health whose particular field related to 
the subcommittee topic. For example, a report on Hispanic nutritional 
status and dietary patterns appears in Volume II, a report on diabetes in 
Hispanics appears in Volume VII, reports relating to cardiovascular 
disease in Hispanics appear in Volume IV. 



Many of the concerns expressed and activities proposed by the 
Hispanic Advisory Group have been incorporated into the recommendations 
of the Task Force and into the more specific activities cited in the 
"Opportunities for Progress" sections of the subcommittee reports. 

Critical Issues Identified by the Hispanic Advisory Group 

In their discussions, the Hispanic Advisory Group included the 
following points as most important in Hispanic health: 

• Data. 

— Vital statistics. At the present time, states vary widely in 
their vital statistics compilation procedures. In areas of conc- 
entrated Hispanic settlement such as Florida and New Jersey, 
Hispanic identifiers are not entered on birth and death records. 
Other states such as California assign ethnic identity by matching 
persons with computerized lists of selected Hispanic surnames. 
Many Hispanics are not recorded because of uncommon surnames, 
non-Hispanic married names, or are classified as White or Black 
based only on appearance. 

— Population-specific medical descriptors. Subgroups within the 
Hispanic population, i.e., Cuban, Puerto Rican, or Mexican origin, 
differ greatly from one other in many variables including demographic 
descriptors and health needs. The lack of population-specific data 
sometimes results in misinterpretion of needs. For example, migrant 
health is sometimes considered the major health problem of Hispanics, 
but actually, migrants represent only one percent of the total 
Hispanic population while 88 percent of Hispanics live in urban 
areas. Specific data in which Hispanics are classified according to 
major subgroups, will permit the the population's medical needs to 

be defined more precisely. 

-- Data are not adequate to confirm the leading national health 
problems for Hispanics. 

— National data collection efforts should include samples of Hispanic 
populations large enough to permit reliable analyses of Hispanic 
health indicators. 

• Limited access to health care systems. 

— Hispanic 1 s limited access to health care facilities and limited use 
of these services frequently stem from lack of awareness of the 
services available and the benefits of good health practices. 

The community health centers now providing care to many Hispanics 
need to assess their relevance to the population in terms of 
bilingual and bicultural staff and health information targeted to 



local interests. Health promotion messages and health care to 
Hispanic groups are most effective when delivered within their 
social frame of reference, focusing on problems known to exist in 
the community. Widespread communications with the Black community, 
for example, about hypertension has led to increased responsiveness 
of that population to health issues in general. 

Health care to Hispanic groups delivered in accord with Hispanic 
cultural preferences is important. For example, many Hispanics 
prefer their medical treatment by one general practitioner rather 
than by multiple specialists. 

Mental health care, particularly because of its basis in communication, 
requires staff members who can not only speak the patients' language 
but appreciate their cultural orientation as well. Hispanic clients, 
who historically have had little exposure to the mental health 
care field, have not benefited from prevention efforts, education, 
early identification of problems, and intervention. 

Lack of medical insurance inhibits participation by Hispanics in 
regular health care. A study by the Rand Corporation showed that 
many fewer Hispanics have health insurance than many other groups. 
With health insurance generally being offered by employers, and 
because this population tends to work for small businesses or for 
themselves, health-related fringe benefits are minimal at best. 



• Lack of role models and advocates within the health professions and 
related government agencies. 

— Hispanic role models and mentors throughout the health professional 
community have dual importance for the Hispanic community: they 
encourage and support Hispanics' joining the health professions, 
and they can serve as advocates for securing attention to Hispanic 
concerns. The allied health professions, in particular, stand to 
gain Hispanic membership if their credibility and accessibility 
are visible through successful Hispanic role models. 

— More jobs and opportunities for advancement of Hispanic applicants 

in the Federal government should be encouraged. A stronger commitment 
by the government's top managers and administrators to increased 
Hispanic employment, and to identification of more positions where 
bilingual and bicultural qualifications are specified as selection 
factors in filling certain positions might promote increased 
employment of Hispanics. 



Hispanic Demographics* 

The Hispanic population of the United States, according to the Census 
Bureau in March 1983, consists of 16 million persons of Spanish ancestry. 
Mexican Americans represent the largest and prohably the most concentrated 
sector of the Hispanic community, numbering 9.9 million. There are 2 
million Puerto Ricans , 1 million Cuban Americans, and 3 million other 
Hispanics in the United States. Most of the demographic information 
thus relates to Mexican Americans. 

Hispanics, with a median age of 23 years, are younger than the U.S. 
population as a whole. Among subgroups, the median age of Cubans is 38, 
while the Puerto Rican and Mexican American median age is 22. Their 
numbers are rapidly increasing. About 6 percent of families have six 
or more children. It is projected that Hispanic Americans will comprise 
the largest minority group in the United States by the year 2000. 

Hispanics are poor. About 30 percent of all families are living 
below the poverty level, compared with 15 percent for the total population. 
Many have not had the opportunity of schooling. One out of every five 
adults 25 years of age or older has completed less than five years of 
school. This pattern is changing, however. In 1970, 45 percent were 
high school graduates, in 1983, 59 percent had graduated from high 
school. In 1970, only 5 percent of Hispanics were college graduates; 
by 1983, the proportion had increased to 10 percent. 

Hispanics live in every state, but 60 percent are concentrated in 
the five southwestern states of Arizona, California, Colorado, New 
Mexico, and Texas. In 1980, more than 50 percent resided in Texas and 
California. One-third of the population of New Mexico are Hispanic. 
One-fifth of the population of Texas and California are Hispanic. 
One-tenth of the population of Arizona, Colorado, Florida, and New York 
are Hispanic. Other states with at least 50,000 Hispanics are Illinois, 
Indiana, Washington, and Ohio. 

Hispanics are more urban than the population as a whole, with nearly 
88 percen-t living in urban areas. In 1980, half of all Hispanics resided 
in central cities — 73 percent of Puerto Ricans, 83 percent of Cubans, 
and 55 percent of Mexican Americans live in cities with a population of 
1 million or more. Yet, many programs are planned in the migrant health 
or rural health field, which do not really affect most of the Hispanic 
population. 

Eighty percent of Hispanics claim Spanish as their mother tongue; 
29 percent speak English poorly or not at all; only 10 percent are 
monolingual in Spanish. Others do not speak Spanish or do so with 
English accents. 



* This is a summary of remarks prepared by Ms. Henrietta Villaescusa, 
a consultant to the Task Force on Black and Minority Health. 



Lack of adequate housing is a problem for many Hispanics. One- 
quarter live in overcrowded housing. The unemployment rate among Hispanics 
is high — 13.8 percent, versus 8.3 percent for the general population. 
The proportion of Hispanic males in the labor force is about 78 percent; 
for women about 49 percent. The largest area of employment is in 
manufacturing. More than one-fourth of the working males are in white 
collar occupations. Hispanic women work in clerical, service, and 
agricultural occupations, earning on the average, less than $4,000 a 
year. Twenty-three percent of Hispanic families are headed by women. 
Forty percent of the 23 percent are Puerto Rican families, while only 13 
percent are Mexican American families. 

As a whole, 29 percent of the United States population is foreign- 
born. Contrary to popular belief, only 33 percent of the Hispanic 
population is foreign-born. 

Hispanics are of all colors: black, brown, and white. They are 
bilingual and bicultural and frequently, multicultural. Hispanics, 
whether they resided in this country for many generations, or came later as 
immigrants, have a common bond that unites them all — their language and 
their culture. Through the years, changes and modifications have occurred 
in both language and culture, depending on geographic areas and outside 
influences. Many Hispanics have been able to make these changes and have 
been accepted into the larger American community. These Americans are not 
often easily identified as Hispanics because they are light skinned, speak 
English without an accent, are urban dwellers, and do not look different. 

For the past 15 years, Hispanic employees in the Department of Health 
and Human Services have worked to promote Hispanic issues within the 
Department. Hispanic Heritage Week, an annual festivity honoring Hispanic 
Americans, is supported by this group. In 1978, the Hispanic employee 
organization of the Public Health Service (PHS), which participates in 
the planning and operation of Hispanic Heritage Week, sponsored a seminar 
focusing on various issues related to the health status of the different 
population groups that make up Hispanics in the United States. The 
proceedings of this seminar, called the Hispanic Mosaic, was the first in 
a series of annual publications about Hispanic health in the United States. 
Subsequent seminars in the PHS concentrated on special groups within the 
Hispanic population, such as Hispanic children, Hispanic families, 
Hispanic women, Hispanic elderly, and Hispanics in science and research. 



Current Issues In 
Hispanic Health 





Sylvia F. Villarreal, M.D. 

Robert Wood Johnson Scholar 

W. K. Kellogg National Fellow 

Assistant Professor of Pediatrics 

University of Colorado Health Science Center, Denver 



CURRENT ISSUES IN HISPANIC HEALTH 
Sylvia F. Villarreal, M.D. 



According to the U.S. 1980 census, the Hispanic population in the 
United States totals 14.6 million people. Mexican Americans comprise 59.8 
percent; 13.8 percent are of Puerto Rican origin, 5.5 percent Cuban, and 
20.9 percent other Hispanic origins (National Center for Health Statistics 
1984a) . This paper constitutes a review of the literature addressing 
Hispanic issues of access, burden of illness, certain disease prevalence, 
Hispanic health providers, suggestions for other areas of research, and 
recommendations for policy initiatives. 

Access 

The Robert Wood Johnson Foundation Special Report "Updated Report on 
Access to Health Care for the American People" addresses the problems of the 
medically underserved (Weisfield 1983). Access is determined by character- 
istics of the population, i.e., health status, age, education, employment, 
income, and insurance status. Access is multifactorial, dependent on 
indicators of process, such as personal source of health care and insurance 
status; utilization indicators demonstrating amount and kind of health care 
received; and satisfaction indicators, such as degree of courtesy shown by 
the health care provider and cost of primary care visit to the client 
(Andersen et al. 1981). In order to understand access of the Hispanic 
population to the health care system, these characteristics will be de- 
scribed individually. 

Age 

Age distributions of the distinct Hispanic groups vary considerably 
(Davis et al. 1983). The Cuban-American population is proportionately more 
elderly, with 16 percent of all Cuban Americans 65 years of age or older 
(figure 1). This is in contrast to 4 percent of all other Hispanic people 
in this age group. Mexican Americans are a younger population; 36 percent 
are under 17 years, compared with 32 percent of all other Hispanic Americans 
(National Center for Health Statistics 1984a) . Being a younger population 
influences fertility, utilization of health care, and prevalences of certain 
injuries and illnesses. As will be discussed in the remainder of this 
paper, this age variable plays a critical role in policy decisions for the 
different groups of Hispanics. 

Education 

Data for 1981 reveal that 45 percent of Hispanic men over 25 years of 
age completed high school (figure 2). This compares with 72 percent of 
white males and 53 percent of black males. Hispanic females did more 
poorly, with 43.6 percent completing school. This figure becomes higher 
when examining the rate of teen pregnancy and educational attainment: In 
1981, only half of all Hispanic mothers had completed at least 12 years of 
schooling, compared with 83 percent of white non-Hispanic women and 64 
percent of black non-Hispanic women (National Center for Health Statistics 



11 



Figure 1. Age-sex composition of the four Hispanic 
groups: 1980 



Mexican American 



Puerto Rican 



Males | 


91 Females 




V/\ 

v/M 

////A 

'////7% 

v/////\ 

V/////M 
V///S/M 
///////I 




M 




\ 


i i I i i I 

6 5 4 3 2 1 ( 


i i i i i i 

) 1 2 3 4 5 6 



75+ 
70-74 
65-69 
60-64 
55-59 
50-54 
45-49 
40-44 
35-39 
30-34 
25-29 
20-24 
15-19 
10-14 
5-9 
0-4 



Males 



Females 



// 
/// 

'AA 
'//A 

//////, 

'/////A 
VAA///X 



i i i i i 

6543210123456 



Percent of population 



Cuban 



Other Hispanic 



Males 



\r / 



Females 75+ 



'/A 

// 

/// 

///, 

'//A 

'///A 

///// 

///// 

///A 

'//A 

'//// 

V//A/L 

////// 

///A 

'■/A 



IIMM ~7T I I I I 



70-74 
65-69 
&>64 
55-59 
50-54 
45-49 
40-44 
35-39 
30-34 
25-29 
20-24 
15-19 
10-14 
5-9 
0-4 



Males 



I I I 



'A 

// 

/// 

'/A. 

'/// 

'///A 

VAAAA 

////// 

'AA//A 

'/////A 

'/////. 

////// 



6543210123456 6543210123456 

Percent of population 

Sources Bureau of the Census 1980 Census Population. General Population Characteristics. 
PC80-1B, various state issues (as presented in Davis et at. 1980. p 11) 



12 



Figure 2. Hispanics, blacks, whites, and total 
population aged 25 and over who completed 4 
years of high school or more: 1970 and 1981. 



Males 



Females 



33.4% 



31 .0% 



455% 



'///// 



//////// 



436% 



34.8% 



'////// 



'///////// 



52.6% 




57.6% 



71 .2% 



40 
Percent 



40 
Percent 



Source: Bureau of the Census. "Population Profile of the United States 1981 " Current 
Population Reports Series P-20, No 374, 1982 Table 6-3 (as presentea in Davis et a/. 1983, 
P 32). 



13 



1984b). Thirty-eight percent of Mexican-American, 46 percent of Puerto 
Rican, and 73 percent of Cuban-American women had attained high school 
education. The level of education is a powerful indicator of access to 
health care, for the less education the head of household has, the poorer 
are the family's health status and access to care (Weisfleld 1983). 

Employment 

Unemployment limits access to health care. The 1982 unemployment rate 
for the last quarter, among Hispanics over age 20, was more than 40 percent 
higher than the national average of 10.7 percent (Davis et al . 1983). In 
1981, Hispanics were more concentrated in lower paid, lesser skilled occupa- 
tions than the overall work force. A study done by the U.S. Commission on 
Civil Rights of minorities* work experience found that Hispanic women, more 
than any other minority group, are paid a lower wage for equal work (Davis 
et al, 1983). Sixteen percent of Hispanic families in 1981 were headed by a 
woman alone (Davis et al. 1983). This figure becomes important when it is 
known that children and adults in families whose head of household was not 
in the labor force are worse off in a number of access-related character- 
istics than the employed and unemployed populations (Weisfield 1983). They 
tend to characterize their health as fair or poor, their ill health keeps 
them from the work force, and the vicious cycle of poverty is continued. 

Income 

In 1981, Hispanics' income was 70 percent that of all white families — a 
median income of $16,401 for Hispanics, compared with $23,517 for the white 
population (Davis et al. 1983). Almost a quarter of all Hispanic families 
fell below the Census Bureau's poverty level, 2.7 times the proportion of 
all white families so classified (Davis et al. 1983). Hispanic poverty 
definitely compromises this population's acces to care. The poor more often 
rank their health status as poor, and poor families have more than twice the 
probability of being unable or failing to obtain care when they needed it 
(Weisfield 1983). 

Insurance 

Hispanics are less likely than any other group to have insurance. 
One-third have neither private health insurance nor coverage through a 
governmental program such as Medicare or Medicaid, which compares with 11 
percent of the general population (Andersen et al. 1981). The adjusted 
rate, controlling for equal education and income levels, is still consider- 
ably below that of 89 percent for the sample population. This implies that 
other reasons still exist for limited Hispanic insurance coverage — perhaps 
factors such as occupational status, underemployment, and part-time jobs and 
their correlation with adequate health insurance coverage (table 1). 

Access Summary 

More than 12 percent of Americans appear to have particularly serious 
trouble coping with the health care system and obtaining care when they need 
it. Fully one-fifth of Hispanic adults, 2.6 million, are medically dis- 
advantaged: They lack health insurance, do not have a regular source of 
medical care because of financial problems or because they did not know 
where to seek care, and they needed care in the previous 12 months but were 
unable to obtain it (Weisfield 1983). In order to best understand burden of 
illness, access illuminates the multifactorial problems incorporated in 
defining illness and ways of approaching its study. Access affects major 



14 



Table 1. Process indicators of access to medical care 
for the Hispanic population of the Southwest 





] 


Percentage 






Pe 


ircentage with 






wi 


th 


Pel 


rcentage with 


waiting time at 






hea 


tlth 


regular source 


regular source of 


Adjustment variables 




insurance 


of 


medical care 


30 


minutes or less 


Hispanics 
















Unadjusted 




66% 


(5.4) 




837. (4.6) 




63% (5.4) 


Adjusted for need 
















Age 




67 


(5.4) 




83 (4.6) 




64 (5.4) 


Disability days 




67 


(5.4) 




84 (4.6) 




65 (5.4) 


Worry 




67 


(5.4) 




84 (4.6) 




65 (5.4) 


All need combined 




68 


(5.4) 




84 (4.6) 




64 (5.4) 


Adjusted for socioeconomic 














factors 
















Education of head 




70 


(5.4) 




83 (4.6) 




70 (5.4) 


Family income 




70 


(5.4) 




84 (4.6) 




68 (5.4) 


Health insurance 




- 






86 (3.5) 




66 (5.4) 


Physician-population 


ratio 


67 


(5.4) 




84 (4.6) 




64 (5.4) 


All socioeconomic combined 


72 


(5.4) 




85 (4.6) 




71 (5.4) 


Adjusted for need and 
















socio-economic fac 


tors 














combined 




75 


(5.1) 




86 (3.5) 




70 (5.4) 


Total U.S. population 




89% 


(0.5) 




88% (0.5) 




64% (0.9) 



Note: Numbers in parentheses in this and subsequent tables are the estimated 
standard errors. 

Source: Andersen et al. 1981, p. 83. 



15 



health policy issues of burden of illness, disease prevalence, and Hispanic 
health manpower. 

Burden of Illness 

The burden of illness model uses the number of deaths as a measure of 
global health status (Rice et al. 1976). Until recently, the Hispanic 
population has not been counted as a distinct racial group in many pre- 
dominantly Hispanic States. Therefore, data necessary to calculate national 
Hispanic excess mortality rate are unavailable. 

Regional data from Texas on relative causes of death are presented in 
tables 2 and 3. One cannot extrapolate these numbers to assume population 
death rate. They are presented to show comparative data and what is cur- 
rently available in both the literature and vital statistics. 

Infant Mortality 

Infant mortality is a critical index of health status. California 
cohort data report 8.8 Hispanic infant deaths/1,000 population, compared 
with 8.5 white infants and 10.2 black infant deaths (Center of Health 
Statistics 1984). Table 4 shows the causes of infant mortality in South 
Texas. The Harris County, Texas, cohort study reveals that Spanish surname 
neonatal and postneonatal mortality rates were only slightly higher than 
non-Spanish rates and considerably lower than black rates (Selby et al. 
1984). This important paper underscores the fact that, when neonatal, 
postneonatal, and risk-factor-specific mortality rates were computed from 
linked birth and infant death records, the paradoxically low mortality rates 
for high birth order, high maternal age, and delayed or absent prenatal care 
can be explained only by loss of infant death data secondary to migration 
and underregistration of deaths. Again, it must be reiterated that excess 
infant mortality rates are valid indicators of health status only when birth 
and death registrations are complete and comprehensive for the entire 
Hispanic population. 

Fertility 

The 1981 Hispanic fertility rate is the highest of any population, 97.5 
births per 1,000 women aged 14-44 years, 50 percent higher than the 65 rate 
for non-Hispanic women (National Center for Health Statistics 1984b) . This 
averages to 2.5 births per Hispanic woman versus 1.8 per white woman (Davis 
et al. 1983). In 1980, a differential in birth and fertility rates existed 
among Mexican-American, Puerto Rican, and Cuban-American groups as illus- 
trated in table 5 and figure 3. In 1981, the fertility rate for Mexican 
Americans was 112.3, 53 percent higher than Puerto Rican women's rate of 
73.5 and more than double the Cuban Americans' rate of 47.2 (National Center 
for Health Statistics 1984b). 

Teen and Unmarried Parentage 

Teen birth rates are higher than those of non-Hispanic white women: 19 
percent of Mexican-American and 23 percent of Puerto Rican women less than 
20 years old had births, compared with 12 percent of white non-Hispanic 
(National Center for Health Statistics 1984b) . Figure 4 shows 1980 data for 
unmarried women. In 1981, nearly one-fourth of all Hispanic births were to 
unmarried mothers (National Center of Health Statistics 1984b) . The con- 
founding factors of teen, unmarried, low educational status, unemployed, and 



16 



Table 2. Ten leading causes of deaths to South Texas residents 

by sex and ethnicity, 1975 



Percent of all causes 



Cause of death 



Anglos 


Mexican- 
Males 


-Americans 


Males 


Females 


Females 


20.20 


20.40 


14.89 


18.95 


35.12 


34.67 


28.88 


29.44 


30.31 


29.54 


24.41 


23.57 


4.81 


5.13 


4.47 


5.87 


8.32 


13.83 


7.16 


9.66 


4.96 


4.14 


(1.81) 


(1.83) 


2.90 


3.06 


2.77 


3.52 



Neoplasms, total 
Heart disease* 

Ischemic heart disease 

Other heart diseases 
Cerebrovascular disease 
Diseases of arteries 
Influenza and pneumonia 
Bronchitis, emphysema, 

and asthma 
Certain causes of mortality 

in early infancy 
Death by violence* 

Accidents 

Suicides 

Homicides 
Infective and parasitic diseases 
Diabetes mellitis 
All other causes 



2.34 



(1.09) 



(0.85) 



(0.64) 



(1.03) 


(0.78) 


3.89 


3.75 


11.70 


6.01 


17.69 


6.45 


7.67 


3.98 


11.93 


5.08 


2.95 


1.56 


(1.65) 


(0.38) 


(1.08) 


(0.47) 


4.11 


(0.99) 


(0.85) 


(0.81) 


(1.59) 


2.32 


(1.05) 


2.01 


3.54 


5.31 


11.53 


13.20 


16.93 


18.13 


n=5738 


n=4479 


n=3650 


n=2639 



*The categories "heart disease" and "death by violence" are in this table for 
the interest of the reader. They are not considered in the ranking of the 10 
leading causes of death. 

Note: Figures in brackets indicate that the particular cause was not among the 
leading 10 for that particular sex and ethnic group. 

Source: Data on death certificates obtained from the Texas Department of Health 
Resources (as presented in Lyndon B. Johnson School of Public Affairs 1979, p. 
23). 



17 



Table 3. Five leading causes of death to South Texas residents 
by age, group, sex, and ethnicity, 1975 



Percent of all causes 



Anglos 



Mexican-Americans 



Cause of death 



Males 



Females 



Males 



Females 



Individuals 14 years of age 
or younger 

Certain causes of mortality in 

early infancy 
Accidents 

Congenital anomalies 
Neoplasms, total 
Influenza and pneumonia 
Infectious and parasitic diseases 
All other causes 



n=191 



n=131 



n=371 



n=266 



30.89 


26.72 


38.27 


37.22 


21.43 


24.08 


14.29 


13.16 


18.85 


19.08 


17.52 


14.29 


4.71 


9.16 


2.97 


(4.89) 


4.71 


3.82 


4.31 


5.64 


(1.56)** 


(2.29) 


2.97 


5.27 


17.85 


14.85 


19.67 


19.53 



Individuals 15 to 29 years of age n=290 



n=99 



n=349 



n=94 



Death by violence* 

Accidents 

Suicide 

Homicide 
Neoplasms, total 

Infective and parasitic diseases 
Major cardivascular diseases 
Complications of pregnancy 
All other causes 



80.29 


64.17 


81.69 


54.25 


58.97 


40.40 


52.44 


39.36 


12.07 


15.15 


8.31 


5.32 


9.25 


8.62 


20.92 


9.57 


7.24 


13.13 


3.44 


11.70 


(0.34) 


— 


2.29 


(3.19) 


3.10 


4.04 


3.44 


11.70 


— 


(2.02) 


— 


5.32 


9.03 


16.64 


9.16 


20.22 



Individuals 30 to 44 years of age n=231 



n=lll 



n=249 



n=133 



Death by Violence* 

Accidents 

Suicide 

Homicide 
Heart disease* 

Ischemic heart disease 

Other heart diseases 
Neoplasms, total 
Cerebrovascular disease 
Diabetes mellitus 
Cirrhosis of liver 
All other causes 



44.60 


30.63 


53.81 


21.81 


21.65 


14.41 


30.12 


15.04 


14.29 


16.22 


(5.22) 


(0.75) 


8.66 


— 


18.47 


6.02 


21.65 


31.54 


11.24 


13.53 


18.61 


— 


7.23 


9.02 


(3.04) 


6.31 


(4.01) 


4.51 


13.85 


25.23 


5.22 


26.31 


(4.76) 


(3.60) 


(3.21) 


4.51 


(0.43) 


3.60 


(0.80) 


(3.01) 


(1.73) 


(0.90) 


7.63 


(3.01) 


12.98 


29.73 


18.09 


27.82 



18 



Table 3. Continued 



Percent of all causes 



Anglos 



Cause of death 



Males 



Females 



Mexican-Americans 
Males Females 



Individuals 45 to 64 years of age n=1568 



Heart disease* 

Ischemic heart disease 

Other heart diseases 
Death by violence* 

Accidents 

Suicide 
Neoplasms, total 
Cerebrovascular disease 
Diabetes mellitus 
Cirrhosis of liver 
All other causes 



n=775 



n=913 



n=537 



37.95 


20.90 


35.05 


26.07 


35.72 


16.00 


30.12 


19.55 


5.23 


4.90 


(4.93) 


6.52 


12.12 


13.68 


12.60 


(5.21) 


5.42 


(4.65) 


8.65 


(3.72) 


6.12 


8.52 


(1.53) 


(0.56) 


27.04 


37.81 


20.48 


29.43 


(3.32) 


6.71 


6.02 


7.64 


(0.89) 


(1.94) 


(3.83) 


7.45 


(3.50) 


(3.13) 


6.02 


(4.10) 


15.18 


15.83 


16.00 


20.10 



Individuals 65 years or older 

Heart disease* 

Ischemic heart disease 
Other heart diseases 

Neoplasms, total 

Cerebrovascular disease 

Diseases of arteries 

Diabetes mellitus 

All other causes 



n=3454 



n=3360 



n=1609 



n=1764 



39.40 


41.01 


39.46 


37.97 


34.19 


35.65 


33.73 


31.39 


5.21 


5.36 


5.73 


6.58 


19.46 


16.88 


18.14 


17.09 


11.90 


16.70 


10.88 


12.80 


4.46 


5.24 


(3.06) 


(3.04) 


(1.27) 


(2.11) 


4.93 


5.97 


23.51 


18.06 


23.53 


23.13 



*The categories "heart disease" and "death by violence" are placed in this table 
for the convenience of readers of this report. They are not considered in the 
ranking of the 10 leading causes. 

**Figures in brackets indicate that the particular cause was not among the 
leading 10 for that particular sex and ethnic group. 

Source: Data on death certificates obtained from the Texas Department of Health 
Resources (as presented in Lyndon B. Johnson School of Public Affairs 1979, p. 
24). 



19 



Table 4. Cause of specific infant mortality rates per 

10,000 live births by ethnicity 

in South Texas, 1975 



Total 



Anglos 



Mexican- 
Americans 



Number of births 
Number of deaths 



44,740 
717 



12,849 
194 



31,789 
461 



Cause of death 



Rate per 10,000 live births 



Infective and parasitic diseases 
Enteritis and other diarrheal 

diseases 
Septicemia 
Avitaminoses and other 

nutritional deficiencies 
Menengitis 

Influenza and pneumonia 
Congenital anomalies 
Certain causes of mortality 

in early infancy 
Birth injury 
Symptoms and ill-defined 

conditions 
All external causes 
Accidents 



8.7 


2.3 


10.4 


4.9 


2.3 


5.0 


2.9 


- 


4.1 


0.4 


_ 


0.6 


2.5 


3.1 


2.2 


8.0 


7.0 


7.2 


31.5 


35.8 


26.7 


81.4 


73.2 


75.5 


47.6 


50.6 


42.2 


12.5 


10.1 


7.6 


7.4 


11.7 


4.7 


6.0 


7.8 


4.4 



Source: For deaths: data on death certificates from the Texas 
Department of Health Resources; for births: Texas Department of 
Health Resources, unpublished data (as presented in Lyndon B. 
Johnson School of Public Affairs 1979, p. 23). 



20 



Table 5. Birth rates and fertility rates, 
by Hispanic origin: nine states, 1979 

Births 
per 1,000 
Ethnic group population 

All origins 15.6 

Non-Hispanic 14.7 

All Hispanic 25.5 

Mexican American 29.6 

Puerto Rican 22.6 

Cuban 8 . 6 

Other Hispanic 25.7 

Note: The nine States are Arizona, California, Colorado, 
Florida, Illinois, Indiana, New Jersey, New York, and Ohio. 

Source: Stephanie J. Ventura. "Births of Hispanic Parentage. 
1979." Monthly Vital Statistics Report , Vol. 31, No. 2, 
Supplement, May 1982 (as presented in National Center for Health 
Statistics 1983, p. 15). 



Births 


per 


1,000 women 


aged 15-44 


66 


7 


63 


2 


100 


5 


119 


3 


80 


7 


39 


7 


95 


9 



21 



Figure 3. Birth rates by age of mother, by Hispanic 
origin of mother, and by race of child for mothers 
of non-Hispanic origin: Total of 22 reporting 
States, 1980. 

Rate per 1 ,000 women in specified group 
200 



150 - 



100 
90 
80 

70 
60 

50 
40 

30 



20 



15 - 



10 



Hispanic 




White \ \ 

non-Hispanic • \ 



\ 



I 



I 



_L 



\ Other 

\ / Hispanic 




J 



15-19 20-24 25-29 30-34 35-39 15-19 20-24 25-29 30-34 35-39 

Age of mother in years 



Source: National Center for Health Statistics, 1983 



22 



Figure 4. Birth rates for unmarried women by age 
of mother, by Hispanic origin of mother, and by 
race of child. Total of 22 reporting States, 1980. 

Rate per 1 ,000 unmarried women in specified group 
150 



/* % Puerto Rican 



\ Mexican 




10 
9 
8 

7 
6 

5 



\ 

J 



I 



15-19 20-24 25-29 30-34 35-44 15-19 20-24 25-29 30-34 35-44 

Age of mother in years 

TRates shown are those for the US white and black populations, regardless of Hispanic origin. 
Source National Center for Health Statistics, 1983 



23 



lack of insurance lead to the perpetuation of the Hispanic feminization of 
poverty. 

Low Birth Weight 

Low birth weight incidence for Hispanic babies is generally comparable 
to that of white non-Hispanic babies. Data for 1981 reveal 5.6 percent of 
Mexican-American infants and 5.8 percent of Cuban-American infants weighed 
less than 2,500 grams (National Center for Health Statistics 1984b). At 
risk for low birth weight were Puerto Rican women with 9.0 percent and black 
non-Hispanic women with 12.7 percent (table 6). Despite this apparently 
favorable distribution of birth weights, research has shown that very low 
birth weight infants of foreign-born Spanish-surname parents had very high 
neonatal mortality rates (Selby et al. 1984). Again, this underreporting 
has been attributed to undocumented alien parents fearing deportation or lay 
midwives fearing prosecution for high-risk pregnancies. The potential 
majority of very low birth weight Mexican-American infants appear more 
likely to die than very low birth weight infants of other ethnicity. The 
term "very low birth weight" needs definition; it was noted to be less than 
3 pounds 5 ounces. More research and documentation are needed to assess the 
true infant mortality of low birth weight Mexican-American infants. 

Childhood Immunizations 

Vaccination status data are not available for Hispanic children. But 
data do exist on the incidence of measles, mumps, and rubella in the four 
border States of Texas, Mew Mexico, Arizona, and California (Proceedings of 
the Conference on Maternal and Child Health 1981) . This area includes only 
18.4 percent of the U.S. population, but a high percentage of the U.S. 
totals of these preventable diseases are found here, such as 43.9 percent of 
total measles (first 43 weeks, 1981), 17.3 percent of total mumps, and 32.6 
percent of total rubella cases. 

Prevalence of Selected Diseases 

Malignancies 

Hispanics have a lower prevalence of cancer than the overall white 
population (Menck 1977; Berg 1980). But biliary, stomach, cervical, and 
renal malignancies have a greater frequency among Hispanics (table 7). 

The incidence of gallbladder cancer is extremely rare in the general 
population. In 350,000 autopsies done in southwest Texas, the age-adjusted 
incidence of this cancer is 2.2/100,000. For Hispanic women, however, the 
incidence is 12/100,000, compared with white women's incidence of 4/100,000 
(Bornstein 1970). The high incidence of gallbladder carcinoma in the 
Mexican-American woman has been correlated to obesity, cholesterol stone 
formation, and diabetes (Bornstein 1970; Fraumeni 1975). 

Cervical cancer is twofold greater in prevalence in Hispanic women 
40-50 years than in white or Native American women in this age group in the 
Southwest (Jordan and Key 1981). This could be explained, perhaps, because 
the critical elements of preventive examinations and education are less in 
Hispanic women. No data were found to explain the increased incidence of 
stomach and renal carcinomas. 



24 



Table 6. Percent low birth weight by age and Hispanic origin of mother 
and by race of child for mothers of non-Hispanic origin: 
total of 22 reporting States, 1981 

Origin of mother 



Hispanic 



Non-Hispanic* 



Central Other 
Age and and 

of All Puerto South unknown 

mother origins 1 * 2 Total Mexican Rican Cuban American Hispanic Total-* White Black 



All ages 


6.9 


6.1 


5.6 


9.0 


5.8 


5.7 


7.0 


7.0 


5.7 


12.7 


Under 15 


13.0 


7.7 


6.7 


14.2 


18.2 


— 


7.3 


14.8 


12.8 


15.8 


15-19 


9.4 


7.5 


6.9 


9.9 


8.8 


7.1 


9.0 


9.8 


7.7 


13.9 


15-17 


10.4 


8.0 


7.2 


10.2 


13.4 


7.5 


10.5 


11.1 


8.7 


14.5 


18-19 


8.8 


7.2 


6.7 


9.7 


7.0 


6.9 


8.2 


9.1 


7.3 


13.5 


20-24 


7.1 


6.1 


5.6 


9.2 


5.8 


5.8 


7.0 


7.3 


5.8 


12.9 


25-29 


5.9 


5.3 


4.8 


8.2 


4.7 


5.5 


6.3 


5.9 


5.0 


11.6 


30-34 


5.9 


5.7 


5.4 


8.4 


5.5 


5.6 


5.8 


6.0 


5.2 


11.5 


35-39 


6.8 


5.9 


5.4 


8.1 


5.2 


5.4 


7.5 


6.9 


5.9 


12.1 


40-49 


8.4 


6.7 


6.4 


10.8 


9.8 


4.9 


6.2 


9.1 


7.9 


13.3 



1 Incudes origin not stated. 

^Figures for non-Hispanic births are based on a 20-percent sample. 

^Included races other than white and black. 

Source: National Center for Health Statistics 1984b. 



25 



Table 7. Relative risks for cancers in Colorado 

Hispanics compared to Non-Hispanic whites 

(comparison group rates=100V Urban 

and rural values averaged.) 



Percent 



Men 



Women 



Biliary tract 

Stomach 

Cervix 

Kidney 

Uterus 

Bladder 

Lung 

Lymphomas 

Large bowel 

Breast 

Prostate 

All cancers 



298 
280 

126 

38 
28 
43 
42 

66 
58 



399 

148 

158 

150 

26 

15 

68 

43 

45 

48 

66 



Source: Berg 1980. 



26 



Gallbladder Disease 

The incidence of gallbladder disease in Mexican-American women was 
approximately three times that of black women, with the incidence of white 
women falling in an intermediate range (Diehl et al. 1980). There was a 
positive association with increasing age and diabetes, and there was no 
correlation with cholesterol, use of oral contraceptives, conjugated estro- 
gens, parity, hypertension, menstruation status, or smoking. 

Cardiovascular Risk Factors 

Hypertension 

"Actual" hypertension in Hispanics is midway between the prevalence of 
whites and blacks (table 8a). Low-income Mexican-American males do have a 
higher prevalence of actual hypertension than does the white male. Mexican- 
American males 60-69 years essentially match the very high rates recorded 
for black males of the same age (table 8b). Hispanic men are at risk for 
having the level of control, diagnosis, and treatment fall behind that of 
national average (table 9). 

Overweight 

The incidence of overweight in the Laredo, Texas, Project, Northern 
California communities, and HANES I was higher in Hispanics than whites, and 
lower than that of Pima Indians (tables 10 and 11). 

Hyperglycemia 

Hyperglycemia, defined as a serum glucose greater than 140 mg./lOO ml, 
was found to be significantly higher in Hispanics than whites but lower than 
that of Pima Indians (table 12). 

Lipids 

Serum lipids revealed cholesterol equivalent in Hispanic men and white 
men but slightly elevated in Hispanic women. Triglyceride levels showed a 
striking elevation in Hispanic women ages 65-74 (table 13). 

Diabetes 

Diabetes is a major health problem in the Hispanic population, account- 
ing for Increased morbidity and mortality (table 14). Trends now show that 
age-adjusted mortality from diabetes is decreasing, yet the gap is still 
enormous between whites and Hispanics in the Southwest (figure 5). Again, 
these data must take into consideration that approximately 53.5 percent of 
the population are Mexican Americans living in south Texas in 1975. 

Gastrointestinal Disease in Children 

No data were found to demonstrate the incidence of acute or chronic 
diarrheal diseases of Hispanic children. Similar to the typical situation 
in developing countries, enteritis and diarrhea ranked as the fifth cause of 
death in the States of Arizona, California, and Texas and the fourth cause 
of death in New Mexico (table 15). Close proximity to Mexico affords these 
border States the problems of undeveloped countries: poor water, poor 
sanitation, poor nutrition, and lack of access to health care. 

Injuries and Violence 

Injuries and violence constitute the major cause of death of youth and 
middle-aged Hispanic men (table 3). In a Houston, Texas, study, Hispanic 
men were three times as likely as white males to be homicide victims. 
Eighty-six percent of Hispanic victims were killed by Hispanic offenders. 
Victim and offenders typically lived at the same address or within a mile or 
two range (Braucht et al. 1980). Little research has gone into the victlm- 



27 



Table 8a. Mean systolic blood pressure (+SD) in Laredo Project 
participants and HANES I subjects, by sex 



HANES I (1) 



Age 


n 


(years) 




Men 

35-44 


18* 


45-54 


37 


55-64 


42 


65-74 


30 


Women 




35-44 


34* 


45-54 


93 


55-64 


70 


65-74 


65 







"Spanish- 














Laredo 




Mexican 




US 




US 




Project 




American" 




white 




black 




129.2 + 19 


1 


124.7 + 12.8 


127 


+ 14 


8 


136.7 


+ 18 


8 


134 + 18.1 




140.1 + 15.0 


134 


7 + 19 


7 


141.7 


+ 28 


2 


132.1 + 25 


7 


139.9 + 19.9 


139 


6 + 20 


4 


144.2 


+ 23 





150.3 + 29 


2 


146.0 + 19.4 


146 


+ 24 


1 


156.6 


+ 28 


3 


119.2 + 20 


6 


122.4 + 19.8 


122 


6 + 18 


7 


130.5 


+ 21 


4 


126.9 + 18 


3 


130.0 + 17.5 


131 


.1 + 22 


2 


150.8 


+ 35 


1 


134.8 + 21 


6 


144.8 + 28.0 


143 


+ 25 


2 


153.4 


+ 27 


4 


155.7 + 25 


5 


150.1 + 21.2 


151 


.6 + 24 


7 


161.3 


+ 28 


.7 



*Age range 40-44 years for Laredo Project participants. 





Table 8b. 


Me 


an 


diastolic blood 


pressure 


j (+SD) 


in Laredo Project 










part 


icipan 


ts and HANES 


I subjects, 


by 


sex 






























HANES I (1) 










"Spanish- 














Age 


n 






Laredo 




Mexi 


.can 




US 


US 




(years) 








Project 




American" 




white 


black 




Men 






























35-44 


18* 






89.6 


+ 13.3 




81.8 


+ 9.7 




84.2 


+ 11.3 


91.2 


+ 12 


1 


45-54 


37 






88.3 


+ 10.6 




86.5 


+ 9.3 




87.5 


+ 12.7 


91.9 


+ 16 


5 


55-64 


42 






82.6 


+ 12.6 




86.8 


+ 7.3 




86.4 


+ 12.0 


93.4 


+ 14 


1 


65-74 


30 






84.5 


+ 11.5 




82.4 


+ 10.6 




84.9 


+ 13.0 


90.9 


+ 14 





Women 






























35-44 


34* 






79.2 


+ 13.0 




78.3 


+ 11.8 




79.3 


+ 12.0 


86.9 


+ 13 


7 


45-54 


93 






80.5 


+ 9.3 




83.7 


+ 10.5 




82.6 


+ 13.1 


93.5 


+ 15 


8 


55-64 


70 






80.9 


+ 10.3 




85.8 


+ 9.9 




86.2 


+ 12.4 


90.6 


+ 13 


9 


65-74 


65 






77.5 


+ 12.4 




81.6 


+ 10.8 




85.4 


+ 12.5 


90.4 


+ 15 


9 



*Age range 40-44 years for Laredo Project participants. 
Source: Stern et al . 1981b. 



28 



Table 9. Control of hypertension in Laredo Project 
participants and IHI* whites and blacks, by sex 

Mexican American 
Percent Black (IHI) (Laredo Project) White (IHI) 

Men 

Previously diagnosed 75 71 79 

On medication 59 56 59 

"Under control" 43 37 44 

Women 

Previously diagnosed 89 97 88 

On medication 78 87 77 

"Under control" 61 77 69 

* Impact of Hypertension Information Program (5). 
Source: Stern et al. 1981b. 



29 



Table 10. Comparison of adiposity indicators between 

Mexican-Americans and other whites in three 

Northern California communities 





Scapula skinfold 


Body mass 


Relative 




thickness (mm) 


index 


weight 




(mean+S.D. ) 


(mean+S . D . ) 


mean+S.D. ) 


Men 








Mexican-American (n=119) 


20+8 


.040+. 006 


1.26+.20 


Other whites (n=587) 


18+8 


.038+. 005 


1.21+.16 


Test statistic* 


2.791 


4.111 


2.876 


Significance 


p<0.01 


p<0.001 


p<0.01 


Women 








Mexican-American (n=180) 


29+11 


.041+. 008 


1.37+.25 


Other whites (n=696) 


21+10 


.036+. 007 


1.21+.25 


Test statistic* 


10.721 


9.837 


8.085 


Significance 


p<0.001 


p<0.001 


p<0.001 



* Based on age and community adjusted mean differences. 
Source: Stern et al. 1975. 



30 



Table 11. Prevalence (%) of overweight by age, sex, and study group 











Men 






Women 




Age 






Mexican 


Americans 


Pima 




Mexican Americans 


Pima 


(years) 


HANES 


I* 


(Laredo Project) 


Indianst 


HANES I* 


(Laredo 


Project) 


Indianst 




No. 


% 


No. 


% 




10% or more 


over 


desirable 


weight 












35-44 


39.1 




9/18 


50.0* 




36.6 


18/34 


52.9* 




45-54 


35.7 




18/37 


48.6 




42.9 


65/93 


69.9 




55-64 


34.0 




15/42 


35.7 




50.2 


47/70 


67.1 




65-74 


32.5 




10/30 


33.3 




49.0 


36/65 


55.4 




20% or more 


over 


de 


sirable 


weight 












35-44 


17.0 




4/18 


22.2+ 


62.9 


23.3 


14/34 


41.2* 


90.8 


45-54 


15.8 




12/37 


32.4 


43.8 


27.8 


46/93 


49.5 


85.7 


55-64 


15.1 




10/42 


23.8 


32.3 


34.7 


31/70 


44.3 


66.3 


65-74 


13.4 




6/30 


20.0 


29.4 


31.5 


26/65 


40.0 


58.1 


Age- 




















adjusted 


15.6 






25.8 


43.1 


29.0 




44.8 


76.3 



* Reference 10. 

t 25% overweight, reference 11. 

* Age range, 40-44 years. 
Source: Stern et al. 1981 a. 



31 



Table 12. Prevalence (%) of hyperglycemia by age, sex, and study group 







Mexican 


Americans 








HANES II 


subset* 


(Laredo 


Projec 


t) 




Pina 


Indianst 


Age range 
(years) 


% 


Age range 
(years) 


No. 




% 


Age range 
(years) 


% 


Men 




40-44 


1/18 




5.6 


35-44 


39.0 


45-59 


3.0 


45-54 
55-64 


3/37 
5/42 




8.1 
11.9 


45-54 

55+ 


35.4 
21.3 


60-75 


5.8 


65-74 


5/30 




16.7 






Age-adjusted 
Women 


4.1 


40-44 


3/34 




10.9 
8.8 


35-44 


30.0 
32.7 


45-59 


3.3 


45-54 
55-64 


5/93 
8/70 




5.4 

11.4 


45-54 
55 + 


50.5 
42.3 


60-75 


4.4 


65-74 


9/65 




13.8 






Age-adjusted 


3.7 








10.1 




41.9 



* Percentages are based on participating sample persons from about 60% of the 64 
HANES II sample locations. The observed values are representative of participating 
sample persons only. See text for further details. 

+ Reference 12. 

Source: Stern et al. 1981a. 



32 



Table 13. Serum cholesterol and triglyceride concentration (mean+SD) 

in Mexican Americans and Anglos 





Hen 






Women 




Age (years) 


Mexican American 
(Laredo Project) 


Anglo 
(LRC white*) 


Mexican American 
(Laredo Project) 


Anglo 
(LRC white*) 


40-44 


241.8+45.8 


Cho] 


.esterol (mg/100 ml) 
206.5+36.5 


215.5+41.3 


194.5+34.4 


45-54 
55-64 


220.4+61.6 
224.9+43.9 




212.4+36.5 
213.6+37.7 


218.5+45.7 
234.6+34.4 


210.9+37.9 
227.2+38.2 


65-74 


207.1+41.7 




210.9+34.8 


238.6+41.8 


228.5+40.1 


40-44 


217.7+56.1 


Triglyceride (mg/100 ml) 
151.4+146.8 


148.3+59.3 


105.3+80.0 


45-54 


190.6+78.5 




151.8+116.8 


163.0+72.2 


116.0+77.7 


55-64 
65-74 


170.7+74.8 
161.9+61.9 




141.7+ 90.4 
133.9+114.2 


177.1+67.1 
181.9+86.6 


125.9+76.0 
130.2+99.5 


Source: 


Stem at al. 1981a. 











33 



Table 14. Ethnic comparison of mortality data 
for diabetes mellitus 

Anglo Mex-Am 



Male Female Hale Female 



Percent of 19 75 deaths 
from Diabetes in 
South Texas* 1.05% 2.01% 3.54% 5.31% 

Average 1969-1971 deaths 
from diabetes per 
10,000 persons in 
Texas** 1.18 1.62 2.80 5.30 

* Not age adjusted. Juvenile and adult. 

** Mexican-American rates are age adjusted to Anglo rates. 

Sources: Texas Health Department, 1975 data; Former, Edwin, 
Jr., "Hortality Differences of 1970 Texas Residents: A 
Descriptive Study," master's thesis, School of Public Health, 
University of Texas Health Science Center at Houston; Sept. 
1975 (as presented in Lyndon B. Johnson School of Public 
Affairs 1979). 



34 



Figure 5. Secular trends in age-adjusted diabetes 
mortality (ICDA code 250) in Bexar County, Texas, 
1970-1976 by sex and ethnic group. 



Age-adjusted mortality per 100,000 population 
80 i— 



60 



40 






20 



10 



Spanish surnamed female 



Spanish surnamed male \ 






^>» 




Other white female 



%. 



1970 



1971 



1972 



1973 
Years 



1974 



1975 



1976 



Source: Stern and Gastill, 1978 



35 



Table 15. Leading causes of death in children by rank 

order, birth through 4 years of age, 1971 

(United States-Mexico border 



















Influenza 


Enteritis 














Congenital 




and 


and 


State 




Acci 


dents 


anomalies 


cancer 


pneumonia 


diarrhea 


Arizona 






1 






2 


3 


4 


5 


California 






1 






2 


3 


4 


5 


New Mexico 






1 






6 


6 


2 


4 


Texas 






1 






2 


3 


4 


5 


Baja California Norte 




2 






** 


** 


1 


3 


Chihuahua 






4 






** 


** 


2 


1 


Coahuila 






5 






** 


** 


2 


1 


Nuevo Leon 






3 






** 


** 


1 


2 


Sonora 






3 






** 


** 


1 


2 


Tamaulipas 






3 






** 


** 


2 


1 


** Not 


in first 


10 


causes o: 


F death. 








Source: 


Proceedings 


of 


the 


Conference 


on Matera 


al and Child 


Health 


1981. 






















36 



precipitated homicide, concomitant alcohol use, and such environmental 
factors as overcrowding, unemployment, and low education. 

Anemia 

Anemia was reported in 17-25 percent of all aged Hispanics in the 1970 
Health and Nutrition Examination Survey (Lowenstein 1981). This was as- 
cribed to nutritional deficiencies, although parasitic and hereditary 
etiologies were not excluded. 

Nutritional Status 

Nutritional deficiencies have been described in multiple studies 
(Lowenstein 1981). The following deficiences were found to be prevalent in 
excess in certain age and sex groups: 

• Infants: iron, vitamin C 

• Children 10-12 years: calcium, vitamins A and C; girls low in iron 

• Pregnant and lactating women: calcium, vitamins A and C, iron 

• All ages: Serum vitamin A found to be 29.9-50 percent low 

Hispanics as Health Care Providers 

Data concerning Hispanic enrollment in medical school are sobering 
(table 16). Although Hispanics comprise 6.4 percent of the total U.S. 
population, medical school entrants include only 4.9 percent Hispanic 
students. 

Role models and teachers are few (figure 6). Only 2.6 percent of 
full-time M.D. and M.D./Ph.D. medical school faculty are minority; of those, 
8.1 percent are Mexican American and 30 percent Puerto Rican. How can one 
expect to train more medical professionals when 45 percent of our youth 
never finish high school? Berryman (1983) of the Rand Corporation believes 
that Hispanics, blacks, and Native Americans will not soon be increasing 
their share of graduate science degrees. Inadequate precollege educational 
preparation is certainly a factor, along with those previously stated as 
barriers to access for health care. 

Further Research Topics 

The following are areas and problems in the Hispanic community that 
warrant further research and, most specifically, the enumeration of Hispanic 
origin in any census studies. 

• Substance abuse: cigarette, drugs, alcohol 

• Reproductive health issues: contraceptive use, sterilization, 
abortions, family planning use 

• Migrant and nonmigrant occupational health risks 

• Hispanic elderly health care issues 

• Bordertown health care issues 

• Sexually transmitted diseases 

• Access issues for Hispanic health policy 

Recommendations 

The following recommendations stem from some of the data presented. It 
is my personal belief that more substantive data must be obtained, Hispanic 
identifiers must be encouraged in any NIH research, and health care policy 



37 



Table 16. Minority women in medical schools 



Minority women now make up 20 percent of new first-year female 
entrants to U.S. medical schools. (See box.) Women, both minority and 
white, comprise 48 percent of the new entrants. Copies of a summary of 
the 1983-84 medical school admissions report are available from the 
Association of American Medical Colleges, Public Affairs Dept., Suite 200, 
One Dupont Circle, NW, Washington, DC 20036. 

First-year new entrants to US medical schools 

1983-84 



Racial/Ethnic Group 

US citizens 
White 
Black 

American Indian/ 
Alaskan native 
Mexican American/ 

Chicano 
Puerto Rican 
(Mainland) 
Other US students 
Asian or Pacific 

islander 
Puerto Rican 

(commonwealth) 
Other Hispanic 
Unidentified 
Foreign 

TOTAL 







% of 


Men 


Women 


Total 


9,299 


4,266 


82. 3X 


527 


445 


5.9 


33 


33 


.4 


174 


91 


1.6 


58 


38 


.6 



627 



322 



5.8 



153 


69 


1.3 


165 


72 


1.4 


4 






70 


34 


.6 


110 


5,370 





Note: US citizens redefined in 1981-82 and thereafter to include 
permanent residents. New entrants figures include only students entering 
medical school for the first time. 

Source: 1980-81, Association of American Medical Colleges Student 
Record System; 1981-82 and thereafter, fall enrollment surveys (as 
presented in On Campus with Women 1984). 



38 



Figure 6. Underrepresented minority full-time M.D. 
and M.D./Ph.D. medical faculty (all schools) — 1982 

All full-time M.D. and M.D./Ph.D. medical faculty 




2.6% Minority faculty 



Blacks 


480 


Mexican Americans 


66 


Native Americans 


21 


Puerto Ricans 


245 


Total 


812 



"For the purpose of the program, the term "minority." as defined by the Association of American 
Medical Colleges, is used to include blacks, Mexican Americans, native Americans, and Puerto 
Ricans residing in the United States. 

Source: Participation of Women and Minorities on U.S. Medical School Faculties, 1982. AAMC. 
Washington, D.C., July 1982, p. 28. 



39 






decisionmaking must realize that much data are regional and most probably an 
underrepresentation of accurate numbers. 

1. Encourage continued recognition by the National Center for Health 
Statistics of the Hispanic population. Oversampling of Hispanics 
is necessary to obtain appropriate sample size. 

2. Greater allocation of funding is needed for primary research in 
disease prevalence and sociocultural and economic issues affect- 
ing Hispanics, as well as recognition by NIH that younger His- 
panic researchers need adequate time, resources, and support. 

3. Increases in enrollment and retention of Hispanic students in all 
fields of health care are indicated. Consider programs such as 
the University of Colorado, Boulder, Center for Education and 
Science, Technology and Society's high school curriculum for 
teaching science and health. This will increase exposure to 
science and health to Hispanic adolescents. 

4. Stanford University's Center for Chicano Studies has developed a 
Hispanic Health Database. This is an online computer search 
service with available telecommunications for national access. 
Funding should be allocated to such databases to facilitate their 
use and continued expansion. They could be used as national 
documentation centers. 

5. Ecological design research in the subpopulations of Hispanics and 
their pertinent issues in health care access should take place. 

6 . Research is needed on the issue of insurance access for Hispanic 
populations. 

7. Researchers interested in secondary data analysis, i.e., Hispanic 
HANES, should be encouraged. This type of data will enable more 
information pertinent to Hispanics to be studied and disseminated 
on a national level. 

8. The education of health care providers and policy makers in the 
Hispanic culture and health issues should be encouraged. Con- 
sider the American Medical Association's educational directive on 
teaching cultural perspectives to practicing physicians. En- 
courage the development of teaching in medical schools in the 
Hispanic culture, its diversity, and health care issues. 






40 



References 

Andersen, R. ; Lewis, S.; Giachello, A.L.; et al. Access to medical care 
among the Hispanic population of the Southwestern United States. Journal of 
Health and Social Behavior 22(March) : 78-89. 1981. 

Association of American Medical Colleges. Participation of Women and 
Minorities on U.S. Medical School Faculties 1982. Washington, D.C.: the 
Association, 1982. p. 28. 

Berg, J.W. The real cancer risks in Colorado. Colorado Medicine 77:241-245, 
1980. 

Berryman, S.E. Special Report: Who Will Do Science? New York: Rocke- 
feller Foundation, 1983. 

Bornstein, F.P. Gallbladder carcinoma in the Mexican population of the 
Southwestern U.S. Pathology and Microbiology 35:189-191, 1970. 

Braucht, G.N.; Loya, F.; and Jamieson, K.J. Victims of violent death. 
Psychological Bulletin 3:300-327, 1980. 

Center of Health Statistics. California Cohort Study preliminary data. 
State of California, Dept. of Health Statistics, August 1984. 

Davis, C; Haub, C. ; and Willette, J. U.S. Hispanics: Changing the face of 
America. Population Bulletin 38(3) (Population Reference Bureau, Inc., 
Washington, D.C. , 1983). 

Diehl, A.K. ; Stern, M.P.; Ostrower, V.S.; and Friedman, P.C. Prevalence of 
clinical gallbladder disease in Mexican-American, Anglo, and black women. 
Southern Medical Journal 73:438-441, 1980. 

Fraumeni, J.F. Cancers of the pancreas and biliary tract: Epidemiologic 
consideration. National Cancer Institute , NIH, 1975. 

Jordan, S.W., and Key, C.R. Carcinoma of the cervix in Southwestern Amer- 
ican Indians: Results of a cytologic detection program. Cancer 47:2523- 
2532, 1981. 

Lowenstein, F.W. Review of the nutritional status of Spanish Americans 
based on published and unpublished reports between 1968 and 1978. World 
Review of Nutrition and Dietetics 37:1-37, 1981. 

Lyndon B. Johnson School of Public Affairs. The Health of Mexican-Americans 
in South Texas. Policy Research Project. Report No. 32. 1979. 

Menck, H.R. Cancer incidence in the Mexican-American. National Cancer 
Institute Monograph 47:103-106, 1977. 

National Center for Health Statistics. Trevino, F.M., and Moss, A.J. 
Health indicators for Hispanic, black, and white Americans. Vital and 
Health Statistics. Series 10, No. 148. DHHS Pub. No. (PHS) 84-1576. Public 



41 



Health Service. Washington, D.C.: Supt. of Docs., U.S. Govt. Print. Off., 
1984a. 

National Center for Health Statistics. Ventura, S.J. Births of Hispanic 

parentage, 1981. Monthly Vital Statistics Report. Vol. 33, No. 8 Supp. 

DHHS Pub. No. (PHS) 85-1120. Hyattsville, Md. : Public Health Service, 
1984b. 

National Center for Health Statistics. Ventura, S.J. Births of Hispanic 
parentage, 1980. Monthly Vital Statistics Report. Vol. 33, No. 6 Supp. 
DHHS Pub. No. (PHS) 1-18. Hyattsville, Md. : Public Health Service, 1983. 

On Campus with Women. University of Washington Press. 13(4), 1984. 
(Available from Association of American Medical Colleges, Public Affairs 
Dept., Washington, D.C.) 

Proceeding of the Conference on Maternal and Child Health Along the Mexico/ 
U.S. Border. El Paso, Texas, Nov. 13-14, 1981. 

Rice, D.P.; Feldman, J. J. ; and White, K.L. "The Current Burden of Illness in 
the United States." Paper presented at the annual meeting of the Institute 
of Medicine, National Academy of Sciences, October 27, 1976. 

Selby, M.L.; Lee, E.S.; Tuttle, D.M. ; et al. Validity of the Spanish surname 
infant mortality rate as a health status indicator for the Mexican-American 
population. American Journal of Public Health 74:998-1002, 1984. 

Stern, M.P., and Gaskill, S.P. Secular trends in ischemic heart disease and 
stroke mortality from 1970 and 1976 in other whites and Spanish surnamed 
individuals in Bexar County, Texas. Circulation 58:537-543, 1978. 

Stern, M.P., et al. Affluence and cardiovascular risk factors in Mexican- 
Americans and whites in three northern California communities. Journal of 
Chronic Diseases 28:623-636, 1975. 

Stern, M.P.; Gaskill, S.P.; Allen, C.R., Jr.; et al. Cardiovascular risk 
factors in Mexican-Americans in Laredo, Texas: I. Prevalence of overweight 
and diabetes and distribution of serum lipids. American Journal of Epi - 
demiology 113:546-555, 1981a. 

Stern, M.P.; Gaskill, S.P.; and Allen, C.R., Jr. Cardiovascular risk factors 
in Mexican-Americans in Laredo, Texas. II. Prevalence and control of 
hypertension. American Journal of Epidemiology 113:556-562, 1981b. 

Weisfield, V. Robert Wood Johnson Foundation Special Report. 1:3-11, 1983. 



42 



National Statistical Data 
Systems And The Hispanic 
Population 







Fernando Trevino, Ph.D. 

American Medical Association 
Chicago, Illinois 



NATIONAL STATISTICAL DATA SYSTEMS 
AND THE HISPANIC POPULATION 

Fernando Trevino, Ph.D. 



Four years ago, I was teaching at the University of Texas medical 
school when I received a call from the National Center for Health Statistics 
(NCHS), telling me they wanted to do the nation's first large-scale study of 
Hispanic Americans. They asked me if I would come and work for them and 
help them put together the study from the ground up. Being straight out of 
graduate school, I knew no better and accepted that challenge. Somehow we 
made it, and the study will be completed this December (Trevino and Moss 
1984). I really think it speaks well to the dedication of the Public Health 
Service that they were able to put such an effort on and do it as well as 
they did. 

While I was at the National Center, I began to look at some of the 
other data systems and explore what could or could not be done in terms of 
producing data on the Hispanic population. One of my main interests in 
coming to Washington stemmed from the fact that I had been out in the field, 
like so many of my colleagues. It is very distressing. You are out there, 
and you see the needs. You are constantly surrounded with poor people. 
They can't afford medical care. They have great needs, and you can't get 
the resources to serve them, because you can't prove what their health needs 
are. I know that all of you working with your agencies recognize the fact 
that any applicant has to document his or her needs very well in order to be 
competitive. 

I began to get very interested in producing some of those needed data. 
Today, I would like to share with you my perceptions regarding the three 
largest data collection systems that are operated in this country. NCHS 
operates quite a few of them, but I would like to focus on just the three 
major ones. 

Health Interview Survey 

The National Health Interview Survey (HIS) is the principal source of 
information on the health of the civilian noninstitutionalized population of 
the United States. Since its beginning in 1957, it has served as a contin- 
uous survey of approximately 112,000 people per year across the country. 

I would like to discuss the HIS in terms of its measurement components, 
because I think they offer different opportunities for producing Hispanic 
data. Every one of the 112,000 persons who is interviewed receives a core 
interview, which consists of three basic types of measures. One records 
short-term disability measures such as incidence of acute conditions and 
disability day estimates. It produces figures on average number of days per 
person per year that people restrict their activities, stay in bed, or miss 
time from work or school because of illness or injury. 

The second type of measure calculates long-term disability on selected 
chronic conditions and impairments as well as activity limitation. It 



45 



produces figures on the proportion of the population who are unable to 
perform major activities such as working, keeping house, or going to school; 
the proportion of the population limited in the amount or kind of activity; 
and the proportion limited in other types of activity because of permanent 
disability or chronic condition. 

Finally, the HIS collects data regarding measures of health services 
utilization, such as the number of times people see a physician or dentist 
in the course of a year, the percentage of the population hospitalized each 
year, and their average length of hospital stay. 

For more than 25 years, the HIS has rightfully served as the corner- 
stone of the national health data collection systems. The HIS produces 
valuable data by age and sex for the white and black populations. However, 
until very recently, the HIS had been totally incapable of providing esti- 
mates for the Hispanic population. The major limitation of the HIS revolves 
around the fact that the sample design samples Hispanics in proportion to 
their representation in the population. Simply stated, this methodology 
yields too few Hispanics in the sample to allow precise estimates for the 
Hispanic national origin groups. 

Since the core part of the HIS- -that is, the questions that are asked — 
does not change from year to year, we began to study the possibility of 
combining several years' worth of data and calculating annual averages as a 
statistical method for increasing the effective sample size. This method 
turned out to be an effective way of producing many reliable estimates for 
Hispanics. 

We recently completed a report comparing white and black non-Hispanics, 
Mexican Americans, Puerto Ricans, Cuban Americans, and other Hispanics. 
This report was based on 3 years of data, 1978 through 1980, and is based on 
about 323,000 interviews. 

The findings of the report reveal the important need for presenting 
Hispanic data by national origin — that is, not just presenting data for 
whites, blacks, and Hispanics. You really need to break it out according to 
national origin. What we found, at least in the measures that we looked at, 
is that Hispanics usually differ more from each other than they do from 
non-Hlspanlcs. 

We found that whites and blacks are fairly comparable in terms of the 
number of times they go to the doctor in the course of a year. Whites go 
4.8 times a year, and the black population averages 4.6 visits per person 
per year. In comparison, Cuban Americans and Puerto Ricans go to the doctor 
much more frequently — 6.2 and 6.0 visits, respectively. So, Cuban Americans 
and Puerto Ricans go to the doctor more frequently than whites and blacks. 
Mexican Americans, on the other hand, go to the doctor less than anybody 
else. They average 3.7 visits per person per year. 

We found that one-third of all Mexican Americans in the United States 
do not see a physician in the course of a year. This compares with a fourth 
of the white and black populations, Cuban Americans, and other Hispanics and 
one-fifth of Puerto Ricans who do not go to the doctor. 



46 



There are really striking differences in terms of dental utilization. 
We found that fully one-fifth of Mexican Americans 4 years of age and over 
in this country have never been to a dentist. That proportion is twice the 
number of black non-Hispanics and seven times the number of white people who 
also have never been to a dentist in the course of their lives. 

Relative to preventive dentistry, we found that almost one-third of 
Mexican American children between the ages of 4 and 16 have never seen a 
dentist. This proportion was three times as large as white non-Hispanic 
children and twice that of other Hispanic children. 

Cuban Americans comprise the group most likely to be hospitalized in 
the course of a year, even after adjusting for age. Mexican Americans, 
again, are the least likely to be hospitalized. We found that Puerto Ricans 
and blacks have higher rates of work loss days and are proportionately more 
likely to report they are limited in their major activity because of illness 
or injury. 

I believe that is really all we are going to be able to produce out of 
the HIS, except maybe studying the relationships between some of these 
variables that were investigated. But you really can't do much more with it 
the way it is now structured. To do any more than that, we would need to 
consider three recommendations. First, we would have to oversample His- 
panics. While aggregating several years of data from the HIS core is 
effective, it is not efficient and does not allow for a timely analysis of 
cross-cultural disability and utilization patterns. Simply stated, you have 
to wait about 5 years — 3 years to collect the data, then time to analyze and 
clean up what you've collected and be able to report it. 

The HIS would need to be redesigned to produce reliable estimates for 
Hispanics on an annual basis as it does for whites and blacks. The recently 
completed HIS redesign effort recognized the need for data for the black 
population and accordingly recommended oversampling black non-Hispanics. 
Unfortunately, it recommended against oversampling Hispanics, making it 
unlikely that we will have timely data for that population from the HIS. 

Another approach that probably should be taken with the HIS is to 
translate the instruments into Spanish. Eighty percent of Hispanic Amer- 
icans live in households where Spanish is spoken, and about a third of the 
population usually speak Spanish. Yet, the questionnaires have never been 
translated into Spanish. 

Currently, the HIS interview procedure calls for the interviewer or 
some family member who is bilingual to translate freely those questions at 
the time of interview. I really think this practice seriously hampers the 
validity and reliability of the data. 

Third, besides translating the instruments, we should begin to look at 
hiring more bilingual interviewers. The HIS interviewers are part-time 
employees of the U.S. Bureau of the Census. Recently, when we were explor- 
ing this option, I asked the Bureau of Census to figure out how many of 
their interviewers currently were bilingual. Of the 110 interviewers thay 
had out in the field, only 1 was. 



47 



The second part of the HIS is the supplement, which goes into specific 
topics of interest such as health insurance, dental health, or some other 
area. These are different every year, and they are administered only to a 
random subsample of the household. Generally speaking, only one person per 
household receives the supplement interview. Therefore, you can tell 
quickly that this reduces the sample size even further. 

In addition, the topics change from year to year, so you cannot aggre- 
gate the data as we did with the core. You really can't do a whole lot with 
supplement data. One exception concerned the data on health insurance, 
which was asked of every member of the household. Fortunately, it was asked 
every other year in the supplement, so it was possible to aggregate some of 
those data and to begin to compare Hispanics and non-Hispanics in terms of 
their health insurance coverage. 

In a report that we were able to do for "Health: U.S., 1983," we 
learned that black non-Hispanics, Puerto Ricans, and Cubans lack health 
insurance coverage at twice the rate of the white population. Among Mexican 
Americans, the noncoverage rate is 3 x h times as great. Indeed, one-half of 
all Mexican Americans in this country with an annual family income of less 
than $7,000 — and I remind you they have large families, so that is a very 
low per capita income — do not have any health insurance. This group is the 
least able to afford out-of-pocket expenditures, which is probably the major 
reason they stay away from a doctor and the hospital. 

At present, the health insurance part of the supplement appears to be 

the only part that can produce reliable estimates for Hispanics. We may be 

able to produce estimates of cross-cultural comparisons of smoking, as we 
have 2 years of data on that for a third of the subsample. 

I think my recommendations for the supplement would be the same as 
those for the HIS core, and that is oversampling Hispanics, translating the 
instruments, and trying to hire more bilingual interviewers in the field. 
If this is not possible, if we can't oversample Hispanics for the core part 
of the HIS, then maybe we could oversample Hispanics for the supplement, for 
the special interviews that we conduct in relation to the HIS. In this way, 
over a period of years we could aggregate data from the core and produce 
estimates, yet, at the same time, be able to produce yearly estimates based 
on the supplement for the Hispanic population. 

Health and Nutrition Examination Survey 

The second national data collection system I would like to talk about 
is the National Health and Nutrition Examination Survey, the HANES. I am 
somewhat more intimately aware of this system, as I worked with it for 4 
years. The HANES is designed to collect data that can best or only be 
obtained from direct physical examination, clinical and laboratory tests, 
and related measurement procedures. The HANES is one of our prime sources 
of prevalence data for specifically defined diseases or conditions of ill 
health. It also produces normative health-related measurement data with 
respect to particular parameters such as blood pressure, visual acuity, or 
serum cholesterol level. 



48 



Unfortunately, the sample for the HANES is even smaller than that of 
the HIS; also, it has never oversampled Hispanics. It, too, was extremely 
limited in terms of what it could produce. To be honest with you, it has 
never produced anything on Hispanics. 

Interestingly enough, back in the late 1970s, NCHS asked the National 
Academy for Public Administration to take a look at the HANES Study and to 
make recommendations on how we could improve the quality and content of the 
data. They ended up making a very unusual recommendation about the content 
of the survey. More important, they said that data are missing for very 
important groups, most notably Hispanics. They recommended that NCHS 
consider doing a special study of the Hispanic population. 

In 1982, we fielded the Hispanic HANES as a supplement to the national 
HANES. The Hispanic HANES is designed to collect data on Hispanics compa- 
rable with those collected previously for the white and black populations. 
The sample for the Hispanic HANES included Mexican Americans 6 months to 74 
years of age living in the five Southwestern States. It also included 
Puerto Ricans living in the New York City area and Cuban Americans living in 
Dade County, Florida. 

All interviewers for the Hispanic HANES were bilingual, as were physi- 
cians, dentists, nutritionists, just about everybody who had to collect 
data. In the case of X-ray technicians or people who really didn't have to 
establish a dialog, at least in terms of collecting data, we just provided 
them with training and they were fairly fluent in Spanish, at least in terms 
of telling the person to turn this way or stand that way. All of our 
questionnaires were translated into Spanish with great care, so that these 
instruments would be appropriate for the three major subgroups we were going 
to be looking at. 

I am really pleased, because I think the Hispanic HANES is going to 
produce a wealth of data — data that we have needed for so long. Unfortu- 
nately, the Hispanic HANES is a one-time study. It will end this December. 
From that point on, we will have no incoming data regarding this population. 

Another drawback is that the Hispanic HANES was a special population 
study. It sampled only Hispanics. Therefore, for comparative purposes, you 
need to compare the data with data that were collected for white and blacks 
either several years before the Hispanic HANES took place or several years 
afterwards. That poses a few problems. 

In addition, the Hispanic HANES did not employ a national sample. The 
Hispanic HANES findings will be generalizable only to persons of the same 
national origin who reside in the same geographic area. 

The Hispanic HANES was a marvelous first step for the National Center. 
To ensure the availability of current national epidemiological data for 
Hispanics, however, all future national HANES should oversample Hispanics as 
needed to produce reliable estimates for Hispanics by national origin 
group. The national HANES should capitalize on its experience and continue 
to utilize bilingual interviewers and questionnaires. 



49 



Vital Statistics Records 

Registration of vital events in this country is a local and State 
function. Uniform registration practices and the use of records for na- 
tional statistics, however, have been established over the years through 
cooperative agreements between the States and NCHS. It was not until 1978 
that NCHS recommended for the first time the addition of a Hispanic identi- 
fier for certificates of birth and death. 

At present, 22 States use the Hispanic identifier on certificates of 
death, and 23 States use it on the birth certificate. This provides cover- 
age for about 90 percent of the Hispanic population in the United States. 
However, we still have some problems with the vital statistics systems. 

To date, it is hard to realize, but despite the fact that Hispanics 
have resided in this country for well over 400 years and constitute the 
fifth or sixth largest Hispanic population in the world, we still do not 
know how many Hispanics die each year in the United States. That is a very 
simple estimate, probably the most simple estimate that exists in the area 
of public health. But, unfortunately, we do not know. The state of our 
knowledge of Hispanic health needs would serve as a national embarrassment 
for even the least developed nation, let alone the country with the most 
elaborate and most highly financed health monitoring systems in the world. 
We really ought to consider putting the information obtained from the 
Hispanic identifier on the data use tapes. 

Let me explain that. Right now, we have 22 States that are collecting, 
can produce, or have data on how many Hispanic deaths occur in their 
States. We have a big problem with the State of California, where only 
about 50 percent of the certificates have that item completed. Therefore, 
the Center has established a policy not to put any of the Hispanic identi- 
fiers on the data use tapes that are made available to researchers across 
the country for any State — not just California, but all of them. 

That means that any researcher who wants to look at how many deaths 
occurred in Arizona or Texas, let's say, has to go to those States and 
specifically try to get their data use tapes or get that vital statistics 
office to furnish them the records. It would be a lot simpler if they were 
just on the data use tapes that are paid for by public monies, and they 
could use one data tape and use the States that they so wish to use. They 
would not necessarily have to use California. At present, we will not do 
that for them, so I think that is one of the reasons we have not seen a lot 
of research on this data set. 

NCHS also should conduct a thorough analysis of the quality of the 
recent death record identifier data. We have been collecting them for some 
years. We need to look at some of the most recent data to see how good they 
are and if they are worthy of being analyzed. If so, NCHS should consider 
publishing a report on deaths of Hispanic origin as one of its top publica- 
tion priorities. I can think of no more important finding that the Center 
could publish at this present time. 

The Department of Health and Human Services should support the develop- 
ment and financing of training programs for hospital personnel and funeral 



50 



directors to inform them of the use of the vital statistics, their impor- 
tance to health planning and research, and the protocol for completing the 
ethnic origin item. Many, if not most, of the error and omissions committed 
by persons who fill out the vital records could be reduced through proper 
training. They just simply don't know how to go about doing it. 

The Department of Health and Human Services also should consider 
encouraging the State of California to reconsider its recent legislation 
that specifies the provision of race and ethnicity as optional on the part 
of the informant. It is ironic that this legislation was proposed by 
well-meaning persons to protect the privacy and rights of minority group 
members. Unfortunately, it has adversely affected the data relative to the 
health needs of minorities, and it has been, I think, counterproductive. 

Since the law mandates that it is optional on the part of the inform- 
ant, we think that funeral directors and hospital staff are interpreting the 
law as meaning that they do not have to inquire about race and ethnicity, 
so, in the case of California, we have half the records that don't even have 
that item completed. Obviously, you can't do anything with those data. 
They are too unreliable. 

California is at present the only State in the Union that makes report- 
ing of race and ethnicity optional. All the others require it. 

MCHS should consider encouraging States and other registration areas to 
adopt one common origin question. Again, with the individuality of States, 
we have different States asking the question in different ways. Usually, 
there are no major differences, but it would be a lot better if we could 
have all of the States using the same question. 

NCHS currently is revising the U.S. Standard Certificate of Death 
proposed to States for their adoption. It would be both easy and appro- 
priate to keep a Hispanic origin item on the new certificate of death. 

Finally, NCHS should encourage States that did not incorporate the 
Hispanic origin item on their certificate to do so in an effort to increase 
the coverage rate for Hispanics. Florida includes a Hispanic item on 
certificates of birth but not on certificates of death, making it impossible 
currently to produce a mortality rate for the Cuban American population. 
That should be a priority State. 

The 1980 census enumerated slightly more than 14.5 million Hispanics. 
Adding to this the figure for Puerto Rico, which is not included in the 
census, would yield well over 3 million more Hispanics. If you consider the 
possibility of some undocumented workers who were probably missed by the 
census, and allow for the expansion that has occurred in the fastest growing 
population from 1980 to 1984, it is probable that well over 20 million 
Hispanics now are living in this country. Furthermore, demographic projec- 
tions indicate that our population is doubling in size every 25 years. 
Should social or economic conditions change in Mexico or in Central or South 
America, a possibility that is not entirely remote, we could absorb an 
unprecedented number of documented and nondocumented Hispanic immigrants. 
We must begin to prepare and plan for the inevitable demographic changes we 
will experience in the United States. 



51 



Reference 

Trevino, F.M. , and Moss, A.J. Health indicators for Hispanic, black, and 
white Americans. Vital and Health Statistics . Series 10, No. 148, DHHS 
Pub. No. (PHS) 84-1576. Public Health Service, National Center for Health 
Statistics. Washington, D.C.: Supt. of Docs., U.S. Govt. Print. Off., 1984. 



52 



Selected Hispanic Health 
Issues of the Eighties 

An Annotated Bibliography 




Henrietta Villaescusa 

Executive Director 
Villaescusa Enterprises 
Los Angeles, California 



INTRODUCTION TO THE HISPANIC BIBLIOGRAPHY 



As one of its many efforts to bring information about Hispanics 
to the members and subcommittees of the Task Force on Black and Minority 
Health, the Hispanic Advisory Group commissioned an annotated bibliography 
devoted exclusively to research topics in Hispanic health. While no national 
data on Hispanic mortality and morbidity were available during the tenure 
of the Task Force, many local and regional studies existed in the scientific 
and professional literature which addressed important areas in Hispanic 
health. Gathered from disparate sources, the bibliography brings this 
information together for the first time. 

The Hispanic Advisory Group anticipates that this collection of 
research material will aid researchers, health care providers, policy- 
makers, health planners, and other interested persons in determining 
areas that need further study, applying current research results to the 
improvement and/or expansion of health services, facilitating collaborative 
relationships among investigators, and conducting other activities related 
to improving the health of the various ethnic groups that make up the 
Hispanic population in the United States. 

Articles, monographs, doctoral dissertations, master's theses, and 
books included in the bibliography constitute the body of available 
scientific knowledge about the health conditions of Hispanics. Items met 
criteria established by the Hispanic Advisory Group: current research, 
conducted in the continental United States, reported during the time 
period 1980 to 1985, and published in English. 

The topics covered in the bibliography were confined to the specific 
areas in which the Task Force was interested, including: arthritis 
and lower back pain, cancer, cardiovascular diseases, chemical dependency, 
dental health, diabetes, digestive diseases, environment, infant mortality, 
maternity, nutrition, stress, infectious diseases, respiratory diseases, 
occupational health, and violence relating to accidents, suicide, and 
homicide. 

In compiling the documents reviewed for the bibliography, more than 40 
literature sources were searched for relevant material. 

• Computer literature retrieval services such as ERIC (Education 
Resource Information Center), and MEDLINE, the National Library 
of Medicine's retrieval system that catalogues more than 800,000 
biomedical journal articles. 

• National clearinghouses, such as those in maternal and child 
health, and alcohol information. 



55 



• Bibliographies such as Dissertation Abstracts. 

• University libraries including those of Loma Linda University, 
Norris Medical Library of the University of Southern California 
in Los Angeles, University Research Library, Biomedical Library, 
and Powell Library of the University of California ar Los Angeles, 
and Fresno Community Hospital Library. 



A group of scientific advisors with expertise in specific areas of 
Hispanic health abstracted the large amount of research material identified 
for the bibliography. They were: Dr. David Hayes-Bautista, Dr. Amado 
Padilla, and Dr. Mary Lou de Leon Siantz. 

More than 15,300 documents were screened, 1,036 were read and 
evaluated, and 217 were abstracted for the bibliography. The bibliography 
listings are classified into three sections: 

• Descriptive studies 

• Clinical/scientific studies 

• Reports in the popular press 



The abstracts are formatted as follows: 

• Author(s) listed alphabetically by first author, and year of 
publication 

• Complete title of document 

• Source: including information about where the document appeared. 

• Abstract/summary of the citation, including number of references. 

Each citation has been assigned a number. The subject and title 
indices which follow the abstract section list the number of the citation, 
not the page number. 

A "0 List" section, included as an appendix, consists of documents 
that were reviewed but did not meet the criteria for inclusion. These 
articles, listed according to author, title, and source, but not abstracted, 
might be very useful for researchers interested in background Hispanic 
health issues. 

Data from the Hispanic Health and Nutrition Examination Survey 
(HHANES), not available when this bibliography was assembled, will be 
reported by the National Center for Health Statistics. 



56 






HISPANIC BIBLIOGRAPHY CONTENTS 

Introduction to the Hispanic Bibliography 55 

Descriptive Studies: Entries 1-76 61 

Clinical/Scientific Studies: Entries 77-192 115 

Reports in the Popular Press: Entries 193-217 189 

Subject Index 203 

Title Index 217 

"Q" List — Supplementary titles . 231 

Acknowledgements 238 



Descriptiue Studies 



59 



Author: Bailey, L. B. , Wagner, P. A. , Christakis, G.J., 
Davis, C. G., Appledorf, H. , Araujo, P. E., 
Dorsey, E., & Dinning, J. S. (1982). 

Title: Folacin, and iron status and hematological 
findings in Black and Spanish American 
adolescents from urban, low-income households. 

Source: The American Journal of Clinical Nutrition , 
35, 1023-1032. 

Abstract: The folacin and iron status of 193 adolescents 
from urban low income households were evalu- 
ated. The sample consisted of 161 Black and 
32 Spanish Americans, (nationality unknown) , 
drawn from a section of Miami, Florida. Data 
are not disaggregated for the Spanish American 
sample. Hematological and biochemical data 
demonstrates that folacin and iron status is 
less than adequate in a significant portion of 
the total sample. This reduced red-blood-cell 
folacin concentration suggests that tissue 
stores of this nutrient are being depleted. 
It is supposed that the ability of an adoles- 
cent to maintain normal hematopoiesis under 
stress such as pregnancy would be compromised. 
34 References. 



Author : 



Title: 



Source: 
Abstract: 



Battin, D. A., Barnes, R. B. , Hoffman, D. I., 
Schachter, J., diZerega, G. S., Yonekura, M. , 
& Lynn, M. (1984) . 

Chlamydia trachomatis is not an important 
cause of abnormal postcoital tests in 
ovulating patients. 

Fertility and Sterility , 4_2 (2) , 233-236. 
The possible role of chlamydia trachomatis 
infections in the etiology of infertility is 
studied in a sample of 63 consecutive patients 
undergoing midcycle postcoital tests at the 
Los Angeles County USC Infertility Clinic. The 
patients came from an indigent population of 
predominatly Hispanic origin. Results of the 
endocervical curettage and blood sample test- 
ing showed that chlamydial infections of the 
endocervix are rare and not commonly associ- 
ated with poor postcoital tests. Data were 
not broken down by ethnicity. 15 References. 



Author: Benavides, G. , Silva, B. , Cervantes, A., 

Katona, G. , & Alvares, V. (1984). 

Title: HLA-DR4 and rheumatoid arthritis in Mexican 
Mestizos. 



61 



Source: Arthritis and Rheumatism , 27(11), 1317-1318. 

Abstract: Forty-nine female and three male patients 
with rheumatoid athritis were studied. Pa- 
tients were Mexican mestizos ranging from 31 
to 72 years with a mean age of 46.9. Control 
groups consisted of 301 healthy unrelated 
Mexican mestizos with the same socioeconomic 
and ethnic background as that of the patients. 
HLA typing of the lymphocytes isolated was 
performed using a modification of the National 
Institutes Health technique. The established 
frequency of HLA antigens statistically com- 
pared between groups compared by chi-square 
test with Yates correction. In contrast with 
previous studies on patients with rheumatoid 
arthritis, a higher frequency of HLA-DR 4 was 
not demonstrated. Results suggest that the 
question of association of HLA with rheuma- 
toid arthritis still remains open. Ethnic 
differences are involved in this association. 
4 References. 






4. Author: Bonnheim, M. L. & Korman, M. (1985). 

Title: Family interaction and acculturation in 
Mexican American inhalant users. 

Source: Journal of Psychoactive Drugs , 17(1), 25-33. 

Abstract: Case-control study of 20 Mexican American 
families in Houston. Ten subjects were fami- 
lies with an inhalant abuser child; 10 con- 
trols matched for ethnicity, income and age of 
child. Structured scales measuring family 
interaction and acculturation were applied, 
and open-ended interviews were videotaped and 
analyzed via a Family Interaction Q-sort. 
Families with an inhalant abuser child were 
found to be more disorganized, confused, 
inconsistent and internally conflicted than 
control families. The level of acculturation 
seemed not to explain inhalant abuse. Family 
coping skills appear to be more important than 
level of acculturation in the development of 
an inhalant abusing child. 38 References. 



5. Author: Caetano, R. (1984). 

Title: Hispanic drinking patterns in Northern Cali- 
fornia. 
Source: Hispanic Journal of Behavioral Sciences , 6(4) , 
Abstract: Three independent descriptive, probability 
samples of drinking of the general population 
in three counties in Northern California were 
conducted between 1978 and 1980. Of the total 
sample of 4,510, 634 (about 14%), were self- 



62 



identified as Hispanic, most of whom were of 
Mexican origin. The major instrument was the 
Quantity-Frequency Index. About 79% of the 
Hispanics were interviewed in English. For 
both men and women in the sample, drinking was 
positively associated with being young, and 
single, separated or divorced. For women, 
drinking was also associated with higher in- 
come and education. For men it was associated 
with being Catholic. The major difference in 
drinking when compared with the rest of the 
population in the general sample is that His- 
panic males were more prone to more quantity 
and higher frequency; i.e., they drink more 
often and drink more on each occasion than the 
general population. Women tended to drink 
less than the general population and reported 
higher rates of abstention and lower rates of 
use when drinking. 28 References. 



Author: Caste, C. A., Blodgett, J., Glover, J., & 
Mojica, M. I. (1980) . 

Title: Alcohol abuse and parental drinking patterns 
among mainland Puerto Ricans. 

Source: In COSSMHO' s Hispanic report on families and 
youth . Washington, D.C.: National Coalition 
of Hispanic Mental Health and Human Services 
Organization. 

Abstract: A sample 215 Puerto Ricans, half of whom were 
selected from an alcoholism client population 
and half of whom were non-alcoholic controls, 
were questioned about the quantity/ frequency, 
beverage preferences, social drinking habits 
and reoccurring family problems of their 
mothers and fathers. Prevalence of fathers' 
daily drinking in both groups was so high that 
no relationship between fathers ' pattern and 
offspring alcoholism could be discerned. How- 
ever, alcoholic children were significantly 
more likely to have abstaining mothers 
(60%) . Non-alcoholic mothers participated 
to varying degrees in social drinking. Few 
respondents in either group associated parent- 
al heavy drinking patterns with reoccurring 
family problems. 276 References. 



Author: Chase, H. P., Hambidge, K. M. , Barnett, S. E., 
Houts-Jacobs, M. J., Kris, M. S., Lenz, B. A., 
& Gillespie, J. (1980) . 

Title: Low vitamin A and zinc concentrations in Mexi- 
can American migrant children with growth 
retardation. 



63 



Source: The Journal of Clinical Nutrition , 33J11) , 
2346-2349. 

Abstract: The purpose of this study was to determine 
serum vitamin A concentrations, which had 
been low in earlier surveys (1969 and 1972) 
and to evaluate zinc nutriture, which had not 
been done previously. Population was 102 
Mexican American preschool children (59 male 
and 4 3 female) from migrant farm families who 
were below the 3rd percentile for height, 
weight, or head circumference. The population 
for the study was chosen from the first 102 
children detected in the migrant health pro- 
gram who were low in growth parameters. Serum 
A concentrations were low in 3 6 of 102 chil- 
dren (35%) . Hair zinc concentrations were low 
in 28 of 96 children (29%) and plasma zinc 
concentrations were low in 35 of 94 children 
(37%) . The results of the biochemical assays 
performed suggest that a substantial percen- 
tage of the children in this population who 
have low growth percentiles also have poor 
vitamin A and zinc nutritional status. There 
was no correlation of height percentiles 
with plasma zinc, hair zinc, or serum vitamin 
A. However, further studies are needed to 
determine if there is a relationship between 
growth retardation and zinc and/or vitamin A 
status in the population. 13 References. 



8. Author: 
Title: 



Source: 
Abstract: 



Chitwood, D. D. , & Chitwood, J. S. (1981). 
Treatment program clients and emergency room 
patients: A comparison of two drug-using 
samples. 

The International Journal of the Addictions , 
16(5), 911-925. 

Traditional substance abusers are described as 
criminally involved narcotic-addicted non- 
White male youth. To determine if this profile 
is applicable to both institutionalized drug 
abusers and acute substance abusers treated in 
emergency rooms, data was collected in Miami, 
Florida, interviews with patients prior to 
institutionalization and from information and 
emergency room records on acute abuse pa- 
tients and by age and sex. The underrepresen- 
tation of Hispanic clients was related to drug 
usage patterns, involvement of the family in 
providing care, cost of medical care, and 
under utilization of public health services. 
Females disproportionately used emergency ser- 
vices, whereas drug treatment programs 
consisted mostly of males. Furthermore, the 



64 



largest age group utilizing the emergency and 
treatment was in the 18-23 age group. Compar- 
ing socioeconomic status between drug treat- 
ment program clients and emergency room pa- 
tients revealed lower educational achievement 
and occupational position among treatment 
patients. The data on drug treatment program 
clients supported the traditional profile for 
drug abusers; however, the data on emergency 
room drug-related patients did not. The study 
suggested reevaluation of drug abuse problems 
and treatment programs and their organization 
and utilization with emphasis on providing 
alternative therapies to nontraditional sub- 
stance abuses. 16 References. 



Author: Copeland, D. R. , Silberberg, Y., & Pfeffer- 
baum, B. (1983) . 

Title: Attitudes and practices of families of chil- 
dren in treatment for cancer: A cross- 
cultural study. 

Source: The American Journal of Pediatric Hematology/ 
Oncology, 5(1) , 65-71. 

Abstract: The purpose of this study was to 1) determine 
the prevalence of use of unproven cancer 
therapies in a pediatric oncology population, 
2) assess parental attitudes about standard 
and unproven treatments, 3) determine physi- 
cian awareness of the use of alternative 
treatments, and 4) to examine the relation- 
ship between sociocultural backgrounds and all 
of the above. Information concerning the use 
of unproven treatment methods by families of 
children being treated for cancer was obtained 
from 66 parents of children with cancer. In- 
formation about parental attitudes toward 
conventional and alternative treatments and 
their understanding of them was also collec- 
ted. In addition, physicians were asked about 
their knowledge of the patient's use of al- 
ternative treatment methods and the source of 
the information about such treatment. Because 
the population had a fairly large Hispanic 
group, a Spanish questionnaire was used for 
Spanish-speaking parents. Cross-cultural com- 
parisons were made to assess the differences 
between Hispanics and Anglos in their 
perception of treatment. The results in terms 
of prevalence of use were comparable to those 
obtained in an earlier study. No parents 
reported the use of laetrile. Significant 
differences were found between Anglos and 
Hispanics in their perceptions of the treat- 



65 



ment administered at the hospital. 
9 References. 



10. Author: 

Title: 
Source: 
Abstract: 



Cox, R. A. , Arnold, D. R. , Cook, D., & Lund- 
berg, D. I. (1982). 

HLA phenotypes in Mexican Americans with 
tuberculosis. 

American Review of Respiratory Disease , 
126 , 653-655. 

The purpose of the present study was to extend 
investigations of HLA phenotypes in tuberculo- 
sis patients to include Mexican Americans and 
to compare phenotype frequencies in patients 
with those in healthy, tuberculin skin test 
positive and healthy, tuberculin skin test 
negative persons. A total of 2 00 unrelated 
Mexican Americans, all with Hispanic maternal 
and paternal surnames, were used in this 
study. Ninety-nine patients had pulmonary 
tuberculosis and one had tuberculous meningi- 
tis. One hundred healthy subjects were re- 
cruited from the hospital staff. HLA-A,-B, and 
-C phenotype distributions in the 100 active 
tuberculin skin test positive and 50 healthy 
tuberculin skin test negative Mexican Ameri- 
cans. Although differences existed in the 
phenotype frequencies of 5 antigens (Aw3 0, 
Aw3 3,B7,B15, and B17) among the three study 
groups, these differences were not signifi- 
cant, using p values that were corrected for 
the number of antigens tested. Therefore, 
susceptibility (or resistance) to tuberculosis 
in Mexican Americans does not appear to be 
linked to a specific HLA-A, B, and -C pheno- 
type. 20 References. 



11. Author: Diehl, A. K. (1983). 

Title: Gallstone size and the risk of gallbladder 
cancer. 

Source: The Journal of the American Medical Associa- 
tion , 250 (17), 2323-2326. 

Abstract: The medical records of ten hospitals (located 
in San Antonio, Texas) that maintained cancer 
registries were examined for 1976-1980, to 
yield a sample of 81 gallbladder cancer 
cases. These cases were matched with benign 
gallbladder disease and with non-gallbladder 
disease controls. Of the cases, 69.1% were 
Mexican American. A positive correlation is 
found between size of gallstone and risk of 
gallbladder cancer. 15 References. 



66 



12. Author: 



Source: 
Abstract: 



Dodge, R. (1983) . 

A comparison of the respiratory health of 
Mexican American and non-Mexican American 
White children. 
Chest , 84(5), 587-592. 

This study compared the rates of respiratory 
diseases in Mexican American and non-Mexican 
American White school children (3rd-5th grade) 
living in three small towns of Arizona. 
Participating in the study were 315 Mexican 
American and 281 non-Mexican American chil- 
dren. Parents of these children were asked to 
respond to a questionnaire based on a standar- 
dized questionnaire of the Tucson Epidemi- 
ologic Study of Obstructive Lung Disease. Of 
the participating 596 subjects, 482 completed 
acceptable testing of pulmonary function with 
either of two dry rolling-seal spirometers. 
The findings reported a 6.5% incidence of 
asthma among non-Mexican American children and 
1.9% among Mexican American subjects. The 
rates of respiratory symptoms were nearly 
equal in both groups. Initial and serial 
testing of pulmonary function showed non- 
Mexican American children had significantly 
lower maximum expiratory flows in each year of 
testing. The methods employed in this study 
prevented the investigation of the cause of 
differences in rates of asthma and pulmonary 
function found. If differences in airway size 
existed between the two groups, a different 
maximum expiratory flow rate could have re- 
sulted. In addition, if the size of the air- 
ways determines the risk of asthma in chil- 
dren, then the findings could have stemmed 
from a single difference between groups, a 
difference in airway size. However, it is 
important to realize that without direct com- 
parisons of the size of airways in the ethnic 
groups, such a hypothesis is only speculation. 
Further research is therefore needed to ex- 
plain the results of this study. 16 
References. 



13. Author: 



Title: 



Source: 



Escobar, J. I., Randolph, E. T. , Puente, G. , 

Spiwak, F., Asamen, J. K. , Hill, M. , & 

Hough, R. L. (1983). 

Post-tramatic stress disorder in Hispanic 

Vietnam veterans - clinical phenomenology and 

sociocultural characteristics. 

The Journal of Nervous and Mental Disease , 171 

(10), 585-596. 



67 



Abstract: Forty-one Mexican-origin Hispanic males being 
seen between 1979 and 1982 at a Veterans 
Administration Neighborhood Health Clinic in 
East Los Angeles comprise the sample to ex- 
plore the symptomatology for post-traumatic 
stress disorder (PTSD) . Scales utilized 
include the NIMH Diagnostic Interview Schedu- 
le, the Combat Stress Scale, the Social Net- 
work Questionnaire and the ARSMA Acculturation 
Scale. Data were compared with a small con- 
trol group of Hispanic veterans who had no 
history of mental or physical disorder (N=18) . 
In addition, data from a sample of 29 Hispanic 
veterans with schizophrenic disorders were 
compared. Social networks of the non- 
symptomatic PTSD group were intermediate in 
size, had less frequency of contact with net- 
work members, and network density was greater. 
Highly symptomatic PTSD veterans reported 
significantly smaller networks, fewer contacts 
ouside the family, and more negative emotions 
were directed toward family members, than the 
minimally symptomatic veterans. The levels of 
acculturation in all three groups seemed simi- 
lar, but the PTSD group appeared more alien- 
ated from their cultural heritage than the 
other groups. The study concludes that "rap" 
groups alone may not constitute an adequate 
therapeutic approach, and that more formal 
psychiatric therapies should be additionally 
considered. 46 References. 



L. , Aguilar, L. , 
Schull, W. J. 



14. Author: Ferrell, R. E., Hanis, C, 

Tulloch, B., Garcia, C. , & 
(1984) . 

Title: Glycosylated hemoglobin determination from 
capillary blood samples utility in an 
epidemiologic survey of diabetes. 

Source: The American Journal of Epidemiology , 119 (2) , 
159-166. 

Abstract: As part of an epidemiologic survey to assess 
the prevalence of non-insulin-dependent dia- 
betes mellitus (Type II) , total glycosylated 
hemoglobin was measured from capillary blood 
specimens obtained from a sample of 1880 adult 
individuals (681 males and 1199 females) of 
Mexican American ancestry residing in Starr 
County, Texas, between January 1981 and 
February 1982. Blood glucose was determined 
using the Eyetone Reflectance Colorimeter. 
Diabetic history and medication history were 
determined by interview and confirmed by a 
review of the subject's medical records when 



68 



possible. No significant difference was found 
between males and females. Diabetics were 
found to have significantly higher levels of 
glycosylated hemoglobin than nondiabetics. 
However, among diabetics, there was no 
significant difference between newly diagnosed 
and known diabetics, and known diabetics ta- 
king medication did not differ significantly 
from those not taking medication. An analysis 
of the specificity and sensitivity of glyco- 
sylated hemoglobin, fasting blood glucose, and 
casual blood glucose determinations as 
screening devices in a survey of diabetes 
prevalence reveals that glycosylated hemo- 
globin is superior to casual blood glucose 
determination. The conditions under which 
various screening devices might be more effec- 
tive are discussed. 25 References. 



15. Author: 

Title: 
Source: 

Abstract: 



Frerichs, R. R. , Aneshensel, C. S., Clark, V. 
A., & Yokopenic, P. (1981). 

Smoking and depression: A community survey. 
American Journal of Public Health , 71(6) , 
637-640. 

This study dealt with the epidemiology of 
depression and help-seeking behavior among 
Anglos (N=887) and Hispanics (N=116) . Smoking 
status and symptoms of mental depression were 
determined as part of a cross-sectional commu- 
nity survey of adults in Los Angeles county. 
Nearly 42 per cent of the males and 31 per 
cent of the females were current smokers. 
Smokers compared to nonsmokers reported signi- 
ficantly higher levels of depression as mea- 
sured by the Center for Epidemiologic Studies- 
Depression (CES-D) Index (10.01 vs 8.79, 
p<.05). The differences were not significant, 
however, when analyzed by sex. Furthermore, 
there were no significant differences in the 
CES-D score when comparing those who had never 
smoked, ex-smokers, current smokers who wanted 
to quit, and current smokers who did not want 
to quit. After controlling in a linear regres- 
sion analysis for the effects of income, age, 
employment status, and sex, none of the smo- 
king status variables contributed significant- 
ly to explaining the variance of the CES-D 
score. While both mental depression and smo- 
king are individually major public health 
problems, the results of this investigation 
suggest that there is little relationship 
between the two in the general community. 
Ethnic comparisons were not reported for any 



69 



of the variables investigated. 16 References. 



16. Author: Friedman, J. M. , Pachman, L. M. , Maryjowski, 

M. L. , Radvany, R. M. , Crowe, W. E. , Hanson, 
V., Levinson, J. E., & Spencer, C. H. (1983). 

Title: Immunogenetic studies of juvenile dermatomyo- 
sitis HLA-DR antigen frequencies. 

Source: Arthritis and Rheumatism , 26(2), 214-216. 

Abstract: This experimental study undertakes a multi- 
center collaborative investigation of immu- 
nogenetic factors involved in juvenile derma- 
tomyositis (JDMS) . JDMS is a chronic inflama- 
tory disease of unknown etiology that occurs 
in children and is characterized by a typical 
rash and symmetric proximal myopathy often 
associated with soft tissue calcifications. 
This study reports the results of typing for 
HLA-DR antigens in 17 patients from Chicago, 
18 from Los Angeles, and 16 from Cincinnati. 
The Terasaki trays defining antigens were used 
for typing HLA-DR. The HLA antigen frequen- 
cies were compared to patients and controls of 
similar ethnic origin. Data on normal popula- 
tion frequencies of the HLA-DR antigens were 
obtained from the joint report of the 8th 
International Workshop which included 11 
Whites, 2 Blacks, and 9 Mexicans. The results 
show the estimated relative risk of JDMS for 
Whites with HLA-DR 3 (a gene marker) to be 
3.8%, for Blacks it was 12.9% and for Latin 
Americans it was 18.5%. The HLA association 
report raises the possibility that JDMS may 
be an "autoimmune disease". 13 References. 



17. Author: Fulmer, R. , & Lapidus, L. (1980). 

Title: A Study of professed reasons for beginning and 
continuing heroin use. 

Source: The International Journal of the Addictions , 
15(5), 631-645. 

Abstract: In this empirical study, motives drug addicts 
profess for using heroin (beginning motives as 
compared with motives for continuing) and 
general factors underlying the motive profes- 
sed by addicts are investigated. Eighty adult 
male ex-heroin addicts (including an undis- 
closed number of Puerto Ricans) were given a 
standardized 27-item interview to investigate 
their reasons for beginning and continuing 
heroin use. The relative popularity of mo- 
tives is presented. Changes in popularity of 
motives at different stages of addiction were 
found, and a view of the motivational develop- 



70 



merit of addiction is discussed. An oblique 
rotation factor analysis was used to investi- 
gate relationships between motives. The three 
motives for beginning heroin use professed 
most often by this sample were pleasure, 
curiosity, and peer pressure. Seven under- 
lying factors were identified for "beginning" 
motives, and correlations between the factors 
suggested two contrasting motivational syn- 
dromes. Motives for continuing heroin use 
also yielded seven factors, but with a dif- 
ferent hierarchy of importance. "Continuing" 
factors were generally more complex and more 
frequently correlated with each other than 
"beginning" factors, suggesting that continu- 
ing heroin use is a more multidetermined phe- 
nomenon than beginning, and one in which it is 
more difficult to identify discrete motiva- 
tional syndromes. Implications for future 
research and treatment are suggested. 
18 References. 



18. Author: Gardner, Jr., L. , Stern, M.P., Haffner, S. M. , 

Gaskill, S. P., Hazuda, H. P., & Relethford, 
J. H. (1984) . 

Title: Prevalence of diabetes in Mexican Americans: 
Relationship to percent of gene pool derived 
from Native American Sources. 

Source: Diabetes , 3J1(1)/ 86-92. 

Abstract: Estimations of the prevalence of non-insulin 
dependent diabetes mellitus (NIDDM) in adult 
Mexican Americans and Anglos in three San 
Antonio neighborhoods are presented. The 
study design included an initial home inter- 
view followed by a medical examination in a 
mobile clinic. Data was collected from 1979- 
1981, and the study published in 1984. The 
age-adjusted NIDDM rates (both sexes pooled) 
for Mexican Americans were 14.5%, 10%, and 5% 
for residents of a low-income (N=496) barrio, 
a middle-income transitional neighborhood 
(N=285) , and high-income suburb (N-642) , 
respectively. In Mexican American women, 
though not in men, obesity also declined from 
barrio to suburbs. The authors have previous- 
ly shown, however, that, although obesity is 
an imporatant cause of NIDDM in Mexican Ameri- 
cans, there is a two- to fourfold excess in 
the rate of NIDDM in this ethnic group over 
and above that which can be attributed to 
obesity. They therefore speculated that gene- 
tic factors might also contribute to excess 
NIDDM in this ethnic group. The percent Native 



71 



American admixture of Mexican Americans as 
estimated from skin color measurements was 46% 
in the barrio, 27% in the transitional neigh- 
borhood and 18% in the suburbs. The NIDDM 
rates in Mexican Americans thus paralleled the 
proportion of Native American genes. Further- 
more, the San Antonio Mexican American rates 
were intermediate between the NIDDM rates of 
"full blooded" Pima Indians (49.9%), who pre- 
sumably have close to 100% Native American 
genes, and the San Antonio Anglo population 
(3.0%) and the predominantly Anglo HANES II 
population (3.1%), both of which presumably 
have few if any Native American genes. The 
association of genetic admixture with NIDDM 
rates suggests that much of the epidemic of 
NIDDM in Mexican Americans is confined to that 
part of the population with a substantial 
Native American heritage. 28 References. 



19. Author: 



Title: 



Source: 
Abstract: 



Gaskill, S. P., Stern, M. P., Hazuda, H. P., 
Hoppe, S., Kruski, A., Markides, K. S., 
& Martin, H. (1981) . 

Sociocultural and genetic influence on plasma 
glucose: A comparison of Mexican Americans 
and Anglos in San Antonio. 
Diabetes , 30 (Supp. 1) , 139A. 

Adult-onset diabetes is a major health problem 
among Native Americans. Thirty-five percent 
of Mexican Americans share a common heritage 
with the Native American, as well as a high 
prevalence of adult-onset diabetes. Studies to 
see whether the onset of diabetes was of gene- 
tic or sociocultural origins were undertaken. 
The first test given was to indicate index of 
Native American admixture. This was done by 
testing for skin color with a photoelectric 
meter: the darker the skin color, the greater 
the admixture. The second test was to test 
for plasma glucose levels. There was a 2-hour 
glucose tolerance test given to 411 Mexican 
Americans and 383 Anglo Americans living in a 
low-income bicultural area and in a high- 
income suburban community. Summary of the 
findings indicate that plasma glucose levels 
were lower in the high-income suburban commu- 
nity than in the low-income bicultural commu- 
nity. When height and weight were controlled, 
the difference between the two communities 
remained significant, but the ethnic differ- 
ences were minimized. There seems to be no 
apparent relationship between Native American 
admixture and plasma glucose tolerance levels. 



72 



Finally, a plasma glucose tolerance seems to 
be influenced by a sociocultural factor. 
Abstract. 



20 



Author: 
Title: 



Source; 



Abstract: 



Gilbert, M. J. (1984, November). 
Social epidemiological factors underlying con- 
trasts in Mexican American and Anglo American 
blue- and white-collar drinking patterns . 
Paper presented at the Annual meeting of the 
American Anthropological Association, Denver, 
Colorado. 

In this ethnographic study, the alcohol- 
related practices and patterns of a sample of 
thirty-six Anglo and Mexican American blue- 
and white- collar couples in a California city 
are compared. The study focuses on a compari- 
son of: (1) expression of sex roles in drink- 
ing contexts; (2) range and type of drinking 
setting and companions; (3) range and kind of 
activities associated with drinking; (4) pro- 
portion of public versus private drinking; (5) 
the presence or absence of life cycle transi- 
tion that affect drinking behavior. Findings 
indicate that differences in drinking set- 
tings, occasions, and companions are more 
strongly linked to social class than ethni- 
city; however, ethnic differences are more 
visible across blue-collar than white-collar 
groups. White-collar couples demonstrate a 
much wider range and greater number of drink- 
ing settings, occasions and companions than 
blue-collar couples, with a greater focus 
on couple-oriented drinking. Blue-collar 
Mexican American drinking is predominently 
sex-segregated, male oriented and confined to 
a narrow range of settings and intimate 
companions. Blue-collar Anglo couples' drink- 
ing patterns are far less sex-segregated than 
their Mexican American counterparts', but 
similar in terms of limited number and range 
of companions and settings. 13 References. 



2 1 . Author : 

Title: 
Source: 



Abstract: 



Glynn, T. J. , 
(Eds.) ( 1983) . 
Research issues 31: 



Pearson, H. W. , & Sayers, M. 



women and drugs . 
U.S. Department of Health and 
Public Health Service, Alco- 



Rockville, MD: 
Human Services, 
hoi, Drug Abuse and Mental Health Administra- 
tion, National Institute on Drug Abuse. 
This is a compilation of empirical research 
abstracts and major reviews of theoretical 
views on female addiction. The report is 



73 



divided into two areas of research: psychoso- 
cial and physiological. At the beginning of 
each abstract is a summary of the research 
indicating drug, sample size, sample type, 
age, sex, ethnicity, geographical area, method- 
ology, data collection instrument, date(s) 
conducted and number of references. These 
areas are indexed at the end of the volume for 
quick reference. The report is a follow-up to 
DRUGS AND PREGNANCY, published in 1975, and 
shows the direction of drug abuse by women in 
the 1980s. Over half of the patients treated 
in emergency rooms in 1980 were women. This 
new era of research provides wider examination 
of addiction and pays attention to the singu- 
lar experience of women as drug abusers. Cri- 
ticism of research in this field is discussed, 
such as the overemphasis on the effects of 
drugs on pregnancies and neonates. Suggested 
are areas for future research such as the 
effects of drugs on women's health, identi- 
fying the problems associated with drawing 
into and keeping women on treatment programs, 
identifying personality, attitude, and demo- 
graphic characteristics which may lead to 
potential drug use by women and investigating 
the growing concern of female drug-induced 
criminality. 561 References. 



2 2 . Author : 
Title: 
Source: 

Abstract; 



Goldberg, A. S., Heiner, D. C. , Firemark, H. 
M. , & Goldberg, M. A. (1981, February). 
Cerebrospinal fluid IgE and the diagnosis of 
cerebral cysticercosis . 

Paper presented in part, at the meeting of the 
Federation of Western Societies of Neurologi- 
cal Sciences San Francisco, California. 
Cerebral cysticercosis is a common cause of 
seizures and other central nervous system dis- 
orders and is frequently reported in Mexico, 
Central and South America. It is known that 
many parasitic diseases lead to an elevation 
of serum IgE. This led to a study of cerebro- 
spinal fluid and serum IgE in 69 patients 
diagnosed with cerebral cysticercosis by 
pathological, radiological, or clinical cri- 
teria. Of the sample, drawn from the Harbor- 
UCLA Medical Center in Los Angeles, there were 
35 Mexican-origin patients: 19 had cysticer- 
cosis and 16 did not. A paper disc radio- 
immunoassay was used to measure CSF and serum 
IgE. The mean CSF level in Mexicans with 
cysticercosis was 0.44 IU/ml compared to 0.28 
IU/ml in Mexicans without cerebral cysti- 



74 



cercosis and 0.07 IU/ml in non-Mexicans with- 
out cerebral cysticercosis. No socioecono- 
demographic controls were used. 12 References. 



23. Author: 

Title: 

Source: 
Abstract: 



Gregory, E. M. , Bessman, A. N. , Canawati, H. 
N. & Sapico, F. L. (19S1) . 

Superoxide dismutase levels of E. coli iso- 
lated in diabetic gangrene. 
Diabetes, 30(Suppl.l), 139 A. 

A National Institutes of Health supported 
study of diabetic patients with infested gan- 
grene identified organisms that may be of 
multiple varieties, show varying degrees of 
pathogenicity and have the ability to survive 
in tissue and to destroy tissues in an infect- 
ed site. Five E. coli strains were isolated 
from diabetic infested gangrene patients. 
Cells were extracted by sonic disruption and 
synthesize superoxide dismutase (SOD) was 
measured by the McCord-Fridovich method. In- 
dependent estimates of clinical pathogenicity 
and invasiveness were made and compared with 
the SOD studies. The preliminary reports 
indicate that the invasiveness of the E. 
coli is related to the ability of the organism 
to SOD. (Journal abstract modified) . 



24. Author: Gunby, P. (1980). 

Title: San Antonio heart study compares ethnic 
groups. 

Source: The Journal of the American Medical Associa- 
tion , 244(3), 225. 

Abstract: The University of Texas Heart Science Center, 
San Antonio, is conducting comprehensive stu- 
dies of diabetes, high blood pressure, and 
other cardiovascular risk factors of a broad 
cross section of the Mexican American popula- 
tion. Individuals of Mexican ancestry make up 
about 60% of the total United States Hispanic 
population and San Antonio has a greater pro- 
portion of persons of Mexican descent than any 
other United States city. The study began 
September, 1979, and will continue until 1982. 
Interviews were conducted in middle-class 
neighborhoods of more than 4,000, and are 
currently being conducted in high-income 
neighborhoods. In October, 1980, interviewing 
will begin in low income neighborhoods. 
Households are selected by random sample and 
notified in advance by mail. All adults (25- 
64) in the household are invited to partici- 
pate. Interviews are conducted about health 



75 



knowledge, eating, excercise, smoking habits, 
family background, attitudes and beliefs, and 
use of health resources. Individuals are then 
given a free physical examination in a mo- 
bile unit. Those who participate receive the 
results of their examination, have the results 
sent to their physicians, and are given gen- 
eral and personalized information about good 
health habits. Early findings indicate that 
Anglo Americans have a higher prevalence of 
diabetes and hypertension, abnormal ECGs and a 
slightly lower prevalence of high blood cho- 
lesterol levels than Mexican Americans. 
The San Antonio study is supported by grants 
from the National Heart, Lung, and Blood In- 
stitute and the U.S. Department of Agricul- 
ture's human nutrition program. References. 



25. Author: Gutgesell, M. , Terrell, G. , & Labarthe, D. 

(1981) . 

Title: Pediatric blood pressure: Ethnic comparisons 
in a primary care center. 

Source: Hypertension, 3_(1) , 39-46. 

Abstract: To determine the age of onset of hypertension, 
many investigators study childhood patterns of 
blood pressure. This study reviews the blood 
pressure (BP) determinations previously re- 
corded in a primary care center serving a low 
socioeconomic population and compares the sys- 
tolic blood pressure (SBP) and diastolic blood 
pressure (DBP) distributions within the clinic 
population among the three major ethnic groups 
represented, and also between this clinic 
population and a recently reported standard 
population (Task Force for Blood Pressure 
Control in Children, NHLBI) . The study group 
consisted of 2,810 children 3-17 years of age 
from the Houston area, of whom 49.2% were of 
Spanish surname, 23.4% Black, and 27.4% White. 
As a standard clinic procedure, BP readings 
were obtained from the right arm with the 
subject seated. Comparisons of the average 
SBP by 3-year age groups, by sex, within the 
clinic population showed that Blacks had high- 
er SBPs than children with Spanish surnames or 
Whites in all of the five male subgroups and 
in four of the five female subgroups. Black 
males had higher DBPs than Spanish or Whites 
in four of the five subgroups; Black females 
had higher DBPs in three of the five sub- 
groups. In comparison with the standard popu- 
lation, the overall 95th percentile values for 
both SBP and DBP were lower. Proportionately, 



76 



elevated (BP) readings were most common among 
Blacks and least common among Whites, but this 
difference is largely related to body size. 
These differences between ethnic groups could 
be accounted for statistically, to a great 
extent, by adjusting for height and weight, 
since Blacks were the tallest and heaviest of 
the three groups. 42 References. 



26. Author: Haffner, S. M. , Rosenthal, M. , Hazuda, H. P., 

Stern, M. P., & Franco, L. J. (1984). 

Title: Evaluation of three potential screening tests 
for diabetes mellitus in a biethnic popula- 
tion. 

Source: Diabetes Care , 7(4), 347-353. 

Abstract: This study, published in July, 1984, tested 
the ability of three potential screening tests 
for (non-insulin-dependent) diabetes melitus 
(fasting plasma glucose value > 140mg/dl, 1-h 
postglucose (PG) load value > or = to 200 
mg/dl, and 2-h PG value > 2 00mg/dl) among 13 
diabetic Mexican Americans (MAs) and 50 dia- 
betic Anglo Americans (AAs) using the National 
Diabetes Data Group criteria as the standard. 
The subjects, ages 25-64 years, were partici- 
pants in the San Antonio Heart Study, a popu- 
lation-based survey of diabetes risk factors. 
The sensitivity of the fasting plasma glucose 
(FPG) cutpoint in detecting diabetes was low 
in both AAs (36.0%) and MAs (59.3%) and was 
related to the age-adjusted prevalence rates 
of diabetes in the two ethnic groups (AAs, 
4.9%; MAs, 10.9%). The 2-h PG load cutpoint 
had good sensitivity (> 93%) and specificity 
(>99%) in both ethnic groups. The ethnic 
difference in the sensitivity of the FPG cut- 
point appeared to be related to the greater 
hyperglycemia of diabetic MAs and their devel- 
opment of diabetes at an earlier age, when 
compared with diabetic AAs. Nearly 3 0% of 
diabetic MAs had FPG value > 200 mg/dl as 
contrasted with only 10% of diabetic AAs. The 
difference in severity of hyperglycemia be- 
tween the ethnic groups appears to be un- 
related to ethnic differences in adiposity, 
pharmacologic treatment, or delay in diagno- 
sis, although longer disease duration in MAs 
may explain part of the difference. Current 
investigation is considering whether the 
greater hyperglycemia in diabetic MAs as 
opposed to AAs may be related to greater con- 
sumption of sucrose and/or certain types of 
complex carbohydrates. 22 References. 



77 



27 



Author : 
Title: 



Source: 
Abstract: 



Haffner, S. M. , Gaskill,S. P., Hazuda, H. P., 
Gardner, L. I., & Stern, N. P. (1982). 
Saturated fat and cholesterol avoidance by 
Mexican Americans and Anglos: The San Antonio 
Heart Study. 

Clinical Research , 30(2) , 2 3 7A. 
A study to assess whether Mexican Americans 
and Anglos have similar patterns of fat con- 
sumption. Data was collected from 3 88 Anglos 
and 915 Mexican Americans living in lower, 
middle, and upper class neighborhoods. Fat 
avoidance scores among Mexican Americans in- 
creased dramatically from low-income barrio to 
high income suburb. This suggests that fat 
avoidance in different groups is not a major 
factor in explaining the similarity between 
Anglos and Mexicans in the decline in ischemic 
heart disease. Abstract. 



, Barton, S. E. 
, Tulloch, B. R. , 



C. A., & Schull, W. J. (1983). 

Mexican Americans in Starr 



28. Author: Hanis, C. L. , Ferrell, R. E. 

Aguilar, L. , Garza-Ibarra, A. 
Garcia, 

Title: Diabetes among 
County, Texas. 

Source: American Journal of Epidemiology , 118 (5) , 659- 
672. 

Abstract: A study of Type II (non-insulin dependent) 
diabetes in a county in south Texas that is 
97.9% Spanish ancestry. A random household 
survey of 2,498 persons was tested for the 
symptoms of diabetes mellitus. Age-specific 
prevalence of diabetes for males ranged from 
0% in age 15-24 to 17.6% in those over 75 
years. Rates for females ranged from 0.4% for 
those age 15-24 to a high of 19.0% in the 55- 
64 cohort. In both sexes, the rates are rela- 
tively low for those under 45 years, with a 
sharp increase in those over 45. The sample 
data are compared with national data and show 
that Starr County residents have two to five 
times greater risk. This is compatible with 
mortality data from Texas showing a high rate 
of death due to diabetes in counties with 75% 
or more Spanish ancestry population. 
13 References. 



29. Author: Hansen, V. E. (Ed.). (1984). 

Title: Cardiovascular diseases in Los Angeles, 1979- 

1981 . 
Source: Los Angeles, California: American Heart 



78 



Association-Greater Los Angeles Affiliate, Inc. 
Abstract: This report is on the current status of the 
major cardiovascular diseases among males and 
females in Los Angeles County. It is the 
seventh in a series prepared for the American 
Heart Association-Greater Los Angeles Affi- 
liate Inc., (AHA-GLAA) by the Division of 
Epidemiology, School of Public Health, Univer- 
sity of California, Los Angeles. Statistics 
for this report were derived using tapes pre- 
pared by the California Department of Health 
Services and the Los Angeles County Department 
of Health Services. The mortality patterns 
described are divided into two chronological 
sections: 1) 1979-1981 and 2) 1981, the date 
of most recent mortality information currently 
available. Maps, tables, and graphs present 
mortality patterns by sex and race-ethnicity, 
income, deaths occurring in and out of health 
facilities, and mortality statistics in the 
six communities served by the AHA-GLAA. Find- 
ings from the 1981 first edition of the report 
were: 1) heart disease is the leading cause 
and strokes are the third leading cause of 
death in Los Angeles County, 2) higher death 
rates due to all major cardiovascular diseases 
were for males, 3) Black males had the highest 
risk of heart disease, followed by White males 
with Japanese males having the highest mor- 
tality rates of both heart disease and strokes 
in the Asian group, 5) heart disease rates 
were higher in poor neighborhoods and 6) heart 
disease deaths among the poor were more likely 
to occur outside of a health facility. Find- 
ings from the 1984 edition of the report 
were: 1) crude death rates for heart disease 
declined by 4.4% since 1980 and death by 
strokes by 10.5%, 2) heart disease remained 
the most common cause of death during 1981 
among all major race-ethnic groups, 3) pre- 
mature deaths from acute heart attacks ac- 
counted for 19,000 potential years of life 
lost. References. 



30. Author: 
Title: 



Source: 
Abstract: 



Hazuda, H. P., Hoffner, S. N. , Stern, M. P., 
Rosenthal, M. , & Franco, L. J. (1984). 
Effects of acculturation and socioeconomic 
status on obesity and glucose intolerence in 
Mexican American men and women. 
American Journal of Epidimiology , 120 , 494A. 
This study examined whether increasing differ- 
ences in socioeconomic status and accultura- 
tion among Mexican Americans are associated 



79 



with differences in obesity and glucose intol- 
erence. A total of 1,241 Mexican American men 
and women, ages 25-64 years, were randomly 
selected from three socio-culturally distinct 
neighborhoods in San Antonio, Texas. Socio- 
economic status was measured with the Duncan 
Socioeconomic Index. Acculuration was measured 
with a multidimentional scale reflecting adop- 
tion during adulthood of Anglo American be- 
haviors, attitudes, and values. Analysis were 
done using multiple regression with age ad- 
justment. Socioeconmic status was inversely 
related to obesity in both sexes, but was 
significant only for women. After adjustment 
for socioeconomic status, acculturation was 
inversely and significantly related to obesity 
in both men and women. Socioeconomic status 
was inversely related to glucose intolerance 
in both sexes, but significant only for women. 
After adjustment for socioeconomic status, 
acculturation was inversely related to glucose 
intolerance in both sexes. This relationship 
was not significant in women, but was highly 
significant in men, and remained significant 
even after adjusting for obesity. Findings 
suggest that in women socioeconomic status is 
more important than acculturation for obesity 
and glucose intolerance. For men, accultura- 
tion appear to be the most important factor, 
especially for glucose tolerance. (Abstract 
modified ) . 



31. 



Author : 
Title: 



Source: 
Abstract: 



Hazuda, H. P., Stern, M. P., & Gaskill, S. P. 
(1982) . 

Ethnic and social class differences related 
to CHD mortality decline: The San Antonio 
Heart Study. 

Clinical Research , 3_0(2) , 237A. 
A study to determine what factors have led to 
the decline in coronary heart disease among 
Hispanics. Data was collected from a random 
sample of 937 Mexican Americans and 400 Anglos 
in a higher, middle, and lower class San 
Antonio neighborhood. The three factors exam- 
ined were: 1) knowledge of preventive be- 
haviors, 2) knowledge of the major heart at- 
tack symptoms, and 3) awareness of the need 
for prompt action. Three times as many 
Mexican Americans scored zero on Point 1. 
Four times as many Mexican Americans scored 
zero on Point 2. Smallest ethnic difference 
was in Point 3: 73% for Mexican Americans 
compared to 80% for Anglos. These differences 



80 



fail to explain the similarity in the decline 
of coronary heart disease between Mexican 
Americans and Anglos. (Journal abstract 
modified) . 



32. Author: 
Title: 

Source: 
Abstract: 



Hazuda, H. P., Stern, M. P., Gaskill, S. P., 
Haffner, S. M. , & Gardner, L. I. (1983). 
Ethnic differences in health knowledge and 
behavior related to the prevention and treat- 
ment of coronary heart disease: The San 
Antonio Heart Study. 

American Journal of Epidemiology, 117 (6) , 717- 
728. 

A sample of 1,925 Mexican-origin Hispanics was 
sampled between 1979 and 1981, as part of the 
San Antonio Heart Study. A special algorithm 
was developed to screen out both non- 
Hispanics, and non-Mexican origin Hispanics. 
This algorithm utilized interviewer identifi- 
cation, surnames of parents and reported 
ethnicity of grandparents. The sample was 
stratified by being carried out in three 
neighborhoods of distinct socioeconomic char- 
acteristics: low-income barrio, a transi- 
tional neighborhhood, and a suburb. An Anglo 
sample was simultaneously taken in a 
transitional and suburban area. Questions 
were asked regarding knowledge of coronary 
heart disease (CHD) and preventive behavior. 
When controlled for the three income strata, 
knowledge was not particularly high, but it 
was somewhat higher among the Anglo than the 
Mexican American of similar socioeconomic 
background. Preventive behavior was also some 
what low, but higher for Anglos than for Mexi- 
can Americans. There was a high awareness of 
the need for prompt medical attention in both 
groups, prompting speculation that prompt 
access to treatment when coronary emergencies 
occur may have made a relatively greater con- 
tribution to CHD mortality decline in both 
Mexican Americans and Anglos than did changes 
in lifestyle. 17 References. 



3 3 . Author : 
Title: 



Source: 
Abstract: 



Hettig, J. L. (1982) . 

The relationship between levels of information 
about uterine cancer and pap smear usage in 
low-income Hispanic population. 
Ann Arbor, MI: University Microfilms Interna- 
tional No. 1320252. 

The purpose of this study was to establish if 
a relationship existed between level of infor- 



81 



mat ion about uterine cancer and the utiliza- 
tion of pap smears in a low-income, Hispanic 
population. Seventy-three Hispanic women at- 
tending a prenatal clinic were administered a 
10-item questionnaire. Data were analyzed 
utilizing a chi square. A statistically sig- 
nificant relationship between uterine cancer 
information level and pap smear use was found. 
The findings indicated that while this rela- 
tionship exists, a majority of women had no 
such information. Therefore, a target group 
must be reached with pap smear information. 
This is an important consideration for health 
care providers, especially nurses. 
31 References. 



34. Author: 
Title: 



Source: 
Abstract: 



Hoick, S. E., Warren, C. W. , Smith, J. C. , & 
Rochat, R. W. (1984) . 

Alcohol consumption among Mexican American and 
Anglo women: Results of a survey along the 
U.S. -Mexico Border. 

Journal of Studies on Alcohol, 45(2) , 149-154. 
A review of U.S. alcohol consumption litera- 
ture reveals two recurrent points: 1) Mexican 
American women are more likely than both 
Mexican American men and Anglo women to be 
abstainers or light drinkers, and 2) the ac- 
culturation of Mexican American women into the 
Anglo American culture seems to add stresses 
that are associated with increased alcohol 
use. In this study, a household probability 
survey was conducted of 1233 Mexican American 
women and 798 Anglo women residing along the 
U.S. -Mexico border. A higher proportion of 
abstainers was found among the Mexican Ameri- 
cans than among the Anglos in almost every 
social and demographic category examined 
(age, marital status, education and employment 
status) . Because the level of alcohol con- 
sumption increased markedly with the years of 
education completed, most of the overall 
ethnic differences observed could be accounted 
for by the generally lower level of education 
among the Mexican Americans. However, ethnic 
subgroups of Mexican American women reported 
different levels of alcohol consumption that 
could not be accounted for by differences in 
education, suggesting that additional ethnic 
factors contribute to drinking patterns. 16 
References. 



3 5 . Author : 



Hsu, K. (1984) . 



82 



Title: Thirty years after isoniazid: Its impact on 
tuberculosis in children and adolescents. 

Source: The Journal of the American Medical Associa- 
tion , 25(10), 1283-1285. 

Abstract: This is the final report of 3 years of obser- 
vation of isoniazid prophylaxis and chemo- 
therapy of tuberculosis in children. It in- 
cludes 2,494 patients of whom 51% were Black, 
3 0% White, and 19% Hispanic who completed a 
course of prescribed therapy in Houston and 
who had been under observation for a total of 
15,943 person-years. The effectiveness of 
isoniazid prophylaxis which refers to treat- 
ment of subclinical infection for prevention 
of covert disease was best demonstrated in 
those children infected before 4 years of age, 
because none of them have experienced overt 
disease. Chemotherapy refers to treatment of 
overt pulmonary tuberculosis and was effective 
for existing disease in all ages and prevented 
dissemination. Of those treated for pulmonary 
tuberculosis during childhood, the striking 
absence of adolescent reactivation points to 
the likelihood of a permanent cure. Adequate 
drug therapy is the key to successful treat- 
ment. 10 References. 



M. 



Pathak, D. R. 



G. , Samet , J , 

J. (1985) . 

smoking and lung cancer 

Whites and other Whites in 



in 

New 

145- 
His- 



36. Author: Humble, C. 

Skipper, B. 

Title: Cigarette 
"Hispanic" 
Mexico. 

Source: American Journal of Public Health , 75(2) , 
148. 

Abstract: A case-control study comparing White and 

panic lung cancer patients with smoking 
causes. Of a total sample of 1,290, 362 were 
Hispanic. The total of 521 lung cancer cases 
were those reported from the New Mexico Tumor 
Registry for 1982. 156 cases were Hispanic. 
Controls were selected from randomly generated 
telephone numbers and from Medicare lists for 
those age 65 and over. In the male controls, 
the prevalance of current and previous ciga- 
rette usage was similar in the two ethnic 
groups, but Hispanics smoked fewer cigarettes 
daily. In the female controls, a lower per- 
centage of Hispanics had ever smoked, and 
their usual consumption was less than that of 
other White women. Analysis of the data 
showed comparable risks of cancer in Hispanic 
and White smokers. There was no evidence of 
interaction between ethnicity and cigarette 



83 



smoking. The data imply that the differences 
in lung cancer incidence between Hispanics 
and Whites are largely explained by the pat- 
terns of cigarette smoking of the two groups. 
19 References. 



37. Author: 
Title: 



Source: 
Abstract: 



Joos, S. K. , Mueller, W. H. , Hanis, C. L. , & 
Schull, W. J. (1984) . 

Diabetes alert study: Weight history and upper 
body obesity in diabetic and non-diabetic 
Mexican American adults. 

Annals of Human Biology , 11(2) , 167-171. 
A multidisciplinary study of Type II (non- 
insulin dependent) diabetes was carried out in 
1983. The target sample was Mexican Americans 
in south Texas. A household survey of 10% of 
all adults over 15 was completed in one coun- 
ty, yielding 59 male and 109 female diabetics. 
These were matched with non-diabetics by sex 
and age. Diabetics differed little from non- 
diabetics in overall body fatness at the time 
of examination. History of fatness was dif- 
ferent. Diabetics were heavier than non- 
diabetics at age 18, and continued to gain 
more weight faster and at an earlier age, than 
non-diabetics. Diabetics tend to have more 
trunk fat, especially in the subscapular fold, 
and less lower extremity fat. Fat patterning 
in this population does not appear to be in- 
fluenced by age when weight gain occurred, 
but is related to diabetic status, especially 
in women. 9 References. 



38. Author: 
Title: 

Source: 
Abstract: 



Jorquez, J. (1984) . 

Heroin use in the barrio: Solving the problem 
of relapse or keeping the tecato gusano asleep. 
American Journal of Drug Abuse, _10(1) , 63-75. 
This empirical study describes how Southern 
California "tecatos" or Chicano heroin addicts 
solved the relapse problem and formed nonad- 
dict lives at peace with "square society" and 
interestingly in some cases, with both square 
society and the tecato world. Also incorpo- 
rated into this paper are field data and cli- 
nical observations of active and inactive 
heroin addicts during the period of 1972-1980 
at a major Chicano drug abuse program in the 
Los Angeles harbor area. Life-history inter- 
views with a subsample of 18 ex-tecatos who 
were abstinent from 2.3 to 24.5 years revealed 
that tecatos employ the metaphor of an indes- 
tructable junkie worm or "tecato gusano" 



84 



living in their vicera to explain heroin re- 
lapse and abstinence in a manner essentially 
consistent with learning theories of opioid 
addiction. The study showed that ex-tecatos 
use a variety of coping mechanisms for main- 
taining abstinence and for avoiding "dangerous 
situations" which could trigger heroin craving 
and relapse. The research also revealed that 
being an ex-tecato does not necessarily imply 
living a crime free or nondeviant lifestyle, 
and that the process of working out of an 
addiction involves two complementary social 
adjustment processes termed (a) extrication 
(from the tecato subculture) and (b) accommo- 
dation (to sguare society) . Suggestions for 
utilizing these findings for treatment 
intervention purposes are offered. 29 Refer 
ences. 



39. Author: 

Title: 

Source: 

Abstract: 



Klatsky, A. L. , Sieglaub, A. B., Landy, C. , & 
Friedman, G. D. (1983) . 

Racial patterns of alcholic beverage use. 
Alcoholism , 7(4), 372-377. 

Among 59,766 persons who had routine health 
examinations in the years 1978 through 1980, 
the proportion reporting drinking among self- 
classified racial groups were: White, 89.5%; 
Latin, 84.8%; Japanese, 81.9%; Black, 79.8%; 
Chinese, 68.1%; Filipino, 63.9%. Reported use 
of three or more drinks daily was similar for 
Whites, Latins, and Blacks but was much lower 
in the Asian groups. Men of all races reported 
more drinking than women. A large proportion 
of drinkers in all race-sex subgroups reported 
use of small amounts of alcohol, and most 
non-drinkers reported lifelong abstinence. 
Wine drinking (2+days a week) was favored over 
spirits or beer by Whites of both sexes and 
women of most races; beer use was favored by 
men of all races except White. All race-sex 
groups reported a strong alcohol-cigarette 
smoking association. Comparison with data 
collected 15 years earlier showed a substan- 
tial decline in reported proportions of ab- 
stainers and heavier (3+) drinkers as well as 
apparent narrowing of race-sex differences. 18 
References. 



40. Author: LeBlanc, D. M. (1983) . 

Title: Quality of maternity care in rural Texas . 
Source: Ann Arbor, MI.: University Microfilms Interna- 
tional No. 8408511. 



85 



Abstract: The purpose of the study was to describe re- 
gionalized systems of perinatal care serving 
predominately low income Mexican American 
women in rural underserved areas of Texas. 
The study focused upon ambulatory care and 
allowed for examination of the state health 
care system. The questions posed at the onset 
of the study included: 1) How well do regional 
organizations with various patterns of staff- 
ing and funding levels perform basic functions 
essential to ambulatory perinatal care? 2) 
Is there a relationship between the type of 
organization, its performance, and pregnancy 
outcome? 3) Are there specific recommendations 
which might improve an organization's future 
performance? A number of factors — including 
maldistribution of resources and providers, 
economic barriers, inadequate means of trans- 
portation, and physicians resistance to 
transfer of patients between levels of care 
— have impeded the development of regionalized 
systems of perinatal health care, particularly 
in rural areas. This study has examined the 
"system" of perinatal care in rural areas, 
utilizing three basic regional models — preven- 
tive care, limited primary care, and full 
primary care. Information documented in pa- 
tient clinical records was utilized to compare 
the quality of ambulatory care provided in the 
three regional models. The study population 
included 390 women who received prenatal care 
in one of the seven study clinics. They were 
predominately Hispanic, married, of low in- 
come, with a high proportion of teenagers and 
women over 35. Twenty-eight percent of the 
women qualified as migrants. Results indicate 
that women usually initiated prenatal care 
early in pregnancy with almost half doing so 
in the first trimester of pregnancy. Further, 
75% of the women had or exceeded the recom- 
mended number of prenatal visits. There was, 
however, a low rate of clinical problem recog- 
nition. Data indicate that basic screenings, 
such as lab tests and blood pressure readings, 
were done but that providers were not record- 
ing a recognition of common clinical problems. 
Numerous recommendations are offered to remedy 
this problem. The findings also showed that 
only 60% of mothers had post-partum follow-up, 
but on the positive side 90% of their newborns 
received care. Differences between the various 
clinic sites was also an integral part of the 
findings reported. There were clinic differ- 
ences in both prenatal and post partum care of 



86 



mother and infants. Suggestions were offered 
for increasing the services of clinics that 
had lower clinical service ratings. 118 Refer- 
ences. 



41. Author: 
Title: 



Source: 
Abstract: 



Linn, M. W. , Linn, B. S., & Harris, R. (1981). 
Stressful life events, psychological symptoms, 
and psychosocial adjustment in Anglo, Black, 
and Cuban elderly. 

Social Science & Medicine , 15(E), 283-287. 
The psychological status of high and low 
stress groups in Anglo, Black, and Cuban cul- 
tures are compared. A total of 280 elderly 
subjects living in Florida were given the 
Social Readjustment Scale. The group included 
78 Cubans, 100 Black, and 102 Anglo respond- 
ents, all with an average age of 73.1 years. 
Findings indicate that high and low stress 
produce greater differences on psychological 
variables than does culture. High and low 
stress groups were significantly different, 
particularly in regard to symptoms of somati- 
zation, depression and anxiety. The three 
cultural groups differed significantly in 
social participation and social dysfunction. 
The fact that symptoms differentiated high and 
low stress groups similarly in each culture 
suggests that reactions to such stress as 
death and illness, which occurred frequently 
among these older persons, may be a common 
response that transcends cultural differences. 
31 References. 



4 2 . Author : 
Title: 



Source: 
Abstract: 



Malina, R. M. , Little, B. B. , Stern, M. P., 
Gaskill, S. P., & Hazuda, H. P. (1983). 
Ethnic and social class differences in 
selected anthropometric characteristics of 
Mexican American and Anglo adults: The San 
Antonio Heart Study. 
Human Biology , 55(4), 867-883. 
This study examines age, ethnic, and social 
class differences in the anthropometric cha- 
racteristics of body size, fatness, and esti- 
mated muscularity in a cross-sectional sample 
of 1,328 randomly selected Mexican American 
and Anglos adults, ages 25-64, from San 
Antonio, Texas. The study is designed to 
clarify the extent to which ethnic differences 
in cardiovascular risk factors are due to 
factors of life style as opposed to genetic 
background. The Mexican Americans resided in 
three socioeconomically distinct areas: 



87 



(l)low income barrio, (2) middle income trans- 
itional area, and (3) high income suburban 
area. Anglos resided in only the latter two 
areas. Among the Mexican Americans, stature 
increases with socioeconomic status in both 
sexes. Mexican American men from the three 
social strata do not differ significantly in 
weight, relative weight, Quaetelet's Index 
and subcutaneous fatness. Mexican American 
women from the lowest social stratum are 
heavier and have thicker skinfolds and larger 
arm circumference than women from the transi- 
tional and suburan areas. Suburban women are 
smaller in all dimensions except stature. 
Social class differences in Anglos from the 
transitional and suburban areas parallel those 
for Mexican Americans in the same area. Ethnic 
comparisons within the same socioeconomic 
level show Mexican Americans as shorter, rela- 
tively but not absolutely heavier, and fatter 
at the subscapular but not the triceps 
skinfold site than Anglos. The thicker sub- 
scapular skinfolds of Mexican Americans, coup- 
led with the lack of an ethnic difference at 
the triceps skinfold site, suggests an ethnic 
difference in fat patterning. These findings 
have implications for the definition of obe- 
sity in epidemiologic surveys using anthropo- 
metric techniques, since the sites chosen for 
skinfold measurement may not be equally diag- 
nostic of obesity in different ethnic groups. 
35 References. 






43. Author: 
Title: 
Source: 
Abstract: 



Mascola, L. , Pelosi, R. , Blount, J.H. , Binkin, 
N.J., Alexander, C. E., & Cates, W. (1984). 
Congenital syphilis: Why is it still occur- 
ring? . 
The Journal of the American Medical 



Associa- 



tion, 252(13), 1719-1722. 

The purpose of this report was to analyze 50 
reported cases of congenital syphilis occur- 
ring in Texas out of 159 documented cases in 
the United States. These 50 cases were re- 
viewed to identify the most important charac- 
teristics on which to focus control efforts. 
Twenty-seven infants were Hispanic and 23 
Black. The mothers were young in general with 
a mean age of 22.7 years. Thirty-three were 
unmarried. Thirty-seven of the mothers had 
another living child. All were from minority 
groups. Among women of reproductive age in 
Texas, the rate of syphilis was seven times 
higher among Blacks than Hispanics. However, 



pregnant Black women were only twice as likely 
than Hispanics of being delivered of an af- 
fected infant. The ratio of congenital syphi- 
lis to early lesion syphilis among women of 
reproductive age was four and one-half times 
higher in Hispanics than Blacks. Foreign- 
born Hispanic women were three times as 
likely to deliver an infected child than His- 
panics born in the United States. Prenatal 
care significantly affected the risk for 
delivering an infected child in both Black 
and Hispanic women. The findings suggested 
that in Texas congenital syphilis can be 
reduced by improving prenatal care for 
high-risk populations and by refining case 
finding efforts to control infectious 
syphilis in the community. 25 References. 



44. Author: 
Title: 

Source: 

Abstract: 



Menck, H. R. , & Mack, T. M. (1982). 
Incidence of biliary tract cancer in Los 
Angeles. 

National Cancer Institute Monogram , (62) , pp. 
95-99. 

Incidence of biliary tract cancer data in four 
ethnic groups in Los Angeles county are con- 
sistent with previous reports of a similarity 
between the ethnic-sex distribution of gall- 
bladder cancer and bile lithogenicity, as 
well as that of other biliary cancer and free 
bilirubin. The highest excess of biliary 
cancer was found to be in females of those 
ethnic groups which had the highest average 
parity. Parity correlates such as martial 
status and religion were related to risk. A 
migration effect in Spanish-surnamed and other 
White females was present for both diseases. 
(Author's abstract modified). 



45. Author: 



Title: 



Source: 
Abstract: 



Mueller, W. H. , Joos, S. K. , Hanis, C. L. , 
Zavaleta, A. A., Eichner, J., & Schull, W. J. 
(1984) . 

The diabetes alert study: Growth, fatness, and 
fat patterning, adolescence through adulthood 
in Mexican Americans. 

American Journal of Physical Anthropology , 64 , 
389-399. 

Diabetes Alert is a study of Type II (non 
insulin-dependent) diabetes in Mexican Ameri- 
cans of Texas. A sample of 1,155 individuals 
were randomly selected in Starr County, Texas, 
an agricultural area that is 95% Mexican Amer- 
ican by population. The age range was from 



89 



ten to 70 years and over. Fifteen body meas- 
urements were taken of each subject. The 
children (141 pre-adult males and 17 pre-adult 
females) were growing at about the 50th per- 
centile of the national HANES sample for 
height, weight/height 2 , and triceps and sub- 
scapular skinfolds. Adults were below median 
height but above median Wt/Ht 2 and skinfolds. 
Diabetics compared to non-diabetics, matched 
for age and sex, were more likely to have 
short sitting heights, more upper body fat, 
less lower body fat and were heavier at maxi- 
mun weight and at age 18. Overall results 
show a precipitous weight gain after maturity 
and an association of diabetes with differen- 
ces in anatomical fat patterning. 2 6 Refer- 
ences. 



46. Author: 
Title: 

Source: 



Abstract: 



Nanjundappa, G., & Friis, R. (1984, April). 
Impact of diabetes upon depression among Mexi- 
can Americans . 

Paper presented at Annual meeting of the 
Western Sociological Association, San Diego, 
California. 

A case-control sample comparing diabetic and 
non-diabetic patients. Fifty-six cases were 
matched with 57 controls. This number included 
22 Mexican American cases and 21 such controls. 
The 20 item CES-D depression scale was admi- 
nistered, as was the Social Network Index. 
Diabetic persons had significantly higher 
depression levels than non-diabetics. Mexican 
Americans, diabetics and non-diabetics were 
more depressed than Anglos, both diabetic and 
non-diabetic. Diabetes, insulin dependency, 
and Mexican American ethnicity were associated 
positively with depression, while social con- 
nectedness and full-time employment were nega- 
tively associated with depression. Study was 
conducted in Orange County, California. 17 
References. 



47. Author: 
Title: 

Source: 

Abstract: 



Noble, D. R. (1983). 

Prenatal care and infant outcome in Mexican 
women . 

Ann Arbor, MI.: University Microfilms Interna- 
tional No. 1321097. 

The purpose of this study was to assess the 
influence of early prenatal care on the Apgan 
score and birthweight of infants born to 120 
mothers of Mexican origin receiving prenatal 
care at a community clinic in a Los Angeles 



90 



County tax supported medical center. Mothers 
were divided into two groups, based on the 
gestational age at the initiation of prenatal 
care. The sample was non-randomized. Group 
One had gestational ages of 20 weeks or less, 
while Group Two had gestational ages greater 
than 2 weeks. The Prenatal and Intrapartum 
High Risk Screening System (Hobel, Hyvarinen, 
Okada, & Oh, 1973; 1978) was used in this 
study. Correlation coefficients were deter- 
mined between the criterion variables of 
birthweight, Apgar score at one minute, and 
Apgar score at five minutes and the predictor 
variables of gestational age, parity, number 
of visits, maternal age, risk factor I and 
risk factor II. It was found that both groups 
were similar in respect to age, parity, number 
of prenatal visits, initial, prenatal, and 
intrapartum risk factors. However, 24.1% of 
the first group had infants with Apgar scores 
less than 7 at one minute compared to 3.4% for 
the second group. The first group infants had 
10% birthweight less than 2,500 grams, com- 
pared to 0% for the second group. The results 
did not support other studies in this area. 91 
References. 



48. Author: 
Title: 
Source: 
Abstract; 



Panepinto, W. , Galanter, M. , Bender, S. H. , & 
Strochlic, M. (1980) . 

Alcoholics 1 transition from ward to clinic: 
Group orientation improves retention. 
Journal of Studies on Alcohol , 4_1(9) , 940- 
945. 

Alcoholics who have been released from in- 
patient care require out-patient care after- 
wards. To increase the percentage of former 
in-patients receiving care in an out-patient 
setting, an orientation program was devised at 
the Bronx Municipal Hospital. The approxi- 
mately 600 patients were 35% Black, 35% His- 
panic and 3 0% White. No information about 
identification of Hispanics is given. The 
orientation for Hispanics was conducted in 
Spanish. A control group was not given the 
orientation. In the experimental group, Hispa- 
nics and Blacks were much more likely to re- 
turn for out-patient care than Whites. 10 
References. 



49. Author: 
Title: 



Penk, W. E., Robinowitz, R. , Roberts, W. R. , 

Dolan, M. P., & Atkins, H. G. (1981). 

MMPI differences of male Hispanic American, 



91 



Black, and White heroin addicts. 

Source: Journal of Consulting and Clinical Pychology , 
49(3), 488-490. 

Abstract: Multivariate analyses of the Minnesota Multi- 
phasic Personality Inventory, administered to 
41 Hispanic American (nationality unspeci- 
fied) , 161 White, and 268 Black heroin 
addicts. The results show differences between 
White and minority addicts. Both Black and 
Hispanic better adjusted males were more 
likely to be- come addicted, than the less 
well-adjusted males. By contrast, among White 
males the less well-adjusted were more likely 
to do so. Hispanic males differed from Blacks 
and Whites in demonstrating a greater reluc- 
tance to admit psychological symptoms and a 
higher degree of defensiveness. 4 References. 



50. Author: 
Title: 
Source: 
Abstract: 



Perez, R. , Padilla, A. M. , Ramirez, A., 
Ramirez, R. , & Rodriguez, M. (1980). 
Correlates and changes over time in drug and 
alcohol use within a barrio population. 
American Journal of Community Psychology , 8 
(6) , 621-635. 

The purpose of this study was to investigate 
the abuse of various chemical substances by 
adolescents within several public housing 
projects in the Mexican American East Los 
Angeles Community. In particular this study 
examined alterations in the extent and type 
of drugs presently abused emphasizing the 
exploration of sociodemographic, cultural, and 
personality variables relevant to drug abuse. 
In addition, this study examined the extent 
and determinants of the use of phencyclohexyl 
piperidine HCL (PCP) , alcohol, marijuana, and 
inhalants. The sample was composed of 3 39 
children and adolescents 9 to 17 with 160 
males (47.3%) and 179 females (52.9). The 
median age was 15.51 years with 17.5% 
being between 9 and 12 years of age. The 
remainder were 13 to 17 years old. The sample 
reflected variation in acculturation common 
to the area. New data were collected through 
a questionnaire which included a self-concept 
scale, various items relating to cultural and 
sociodemographic factors, and a number of 
questions relating to the educational experi- 
ences and goals. The questionnaire was admin- 
istered by 10 bilingual/bicultural adolescents 
from the same area as the respondents. Re- 
sults from the study were compared to those 
from a similar survey conducted two years 



92 



previously. The use of inhalants had declined 
when compared to the earlier survey. However, 
use of alcohol and marijuana had increased 
across all age and sex cohorts. The use of 
PCP was found to be extremely high. In 
general, the use of all drugs was predicted by 
age, sex, and number of peers reporting use. 
Self-concept factors, particularly one's self- 
evaluation with respect to others, were also 
significant predicators of marijuana use, 
inhalants and PCP. Alcohol, on the other hand 
was not related to any self-concept factors. 
Language (Spanish-English) used both in the 
home and with peers was related to the use of 
all substances studied. The limitations of 
the study were also discussed, particularly 
due to sampling problems. 14 References. 



51. Author: 
Title: 

Source: 

Abstract: 



Perez, R. (1982) . 

Stress and Coping as determinants of adaptation 
to pregnancy in Hispanic women . 
Ann Arbor, MI.: University Microfilms Inter- 
national No. 8219749 

The effect of stress, social support, and co- 
ping styles on both prepartum anxiety and 
intrapatum processes (labor and delivery com- 
plications, intrapartum analgesia require- 
ments) were explored in a study of a sample of 
Hispanic women. Stress, whether indexed in 
terms of life changes or the women's prepartum 
estimate of labor and delivery pain, was sig- 
nificantly related to prepartum anxiety. More 
interesting was the manner in which stress, 
especially in interaction with prepartum use 
of medical personnel for information and 
reassurance, affected both prepartum anxiety 
and intrapartum analgesia requirements. Ob- 
taining information from medical personnel was 
associated with reductions in prepartum anxi- 
ety only among women experiencing moderate or 
low amount of life change stress. Women re- 
porting high amounts of life change stress 
experienced increases in anxiety levels to 
the extent they sought information from medi- 
cal personnel. This interaction was discussed 
in terms of the ability of a largely English- 
speaking staff to respond to the psychosocial 
concerns of Spanish-speaking patients. The 
significance of these findings was tempered by 
the fact that the social support and coping 
style failed to consistently predict the 
intrapartum criterion variables. Further, 
many stresses by social support or coping 



93 



style interactions were non-significant. 
These failures were attributed to the fact 
that predictor variables did not bear a direct 
relationship with the subject's actual intra- 
partum behavior and emotions. 168 References. 



52. Author: 
Title: 
Source: 
Abstract: 



Rada, R. , Knodell, R, 



Kellner, R. , Herman- 



son, S. M. , & Richards, M. (1981). 
HLA antigen frequencies in cirrhotic and non- 
cirrhotic male alcoholics: A controlled study. 
Alcoholism: Clinical and Experimental Re- 
search , 5(2), 188-191. 

Although epidemiological data suggest that the 
development of cirrhosis in alcohol abusers is 
related to the duration and amount of ethanol 
intake, the fact that only a small percentage 
of alcohol abusers develope cirrhosis remains 
unexplained and suggests a possible predispos- 
ing genetic factor. Several previous studies 
have reported an association between various 
human leucocyte antigens (HLA) and alcoholic 
cirrhosis. The purpose of this study was to 
examine the relationship between HLA antigens 
and the presence or absence of cirrhosis in 
alcoholics. HLA antigen frequencies in Anglo 
and Spanish American alcoholic patients were 
determined and the frequencies of these anti- 
gens were compared between those alcoholic 
patients who have developed cirrhosis and 
those who have not. In addition, HLA antigen 
frequencies in the alcoholic patients were 
compared with a concomitant control group of 
nonalcoholic patients without liver disease. 
This empirical study employed adult males in 
New Mexico and consisted of 68 nonalcoholics, 
74 alcoholics with cirrhosis, and 40 alcohol- 
ics without cirrhosis. A personal interview 
was conducted with each subject about their 
drinking patterns, and the Michigan Alcohol- 
ism Screening Test was also administered. 
Diagnoses of alcoholism were consistent with 
the criteria established by the Criteria Com- 
mittee, National Council on Alcoholism. No 
statistically significant differences in HLA 
frequencies among the ethnic groups were 
found. Comparisons of HLA frequencies between 
cirrhotic and noncirrhotic alcoholic patients 
do not support the hypothesis that individual 
susceptibility to the development of alcoholic 
cirrhosis is genetically determined. 18 Re- 
ferences. (Author abstract modified) . 



94 



53. Author: Ramirez, A. G., Herrick, K. L. , & Weaver, F. J. 

(1981) . 

Title: El asesino silencioso: a methodology for alert- 
ting the Spanish-speaking community. 

Source: Urban Health , June, 44-48. 

Abstract: The purpose of this survey was to establish a 
data base for Baylor's National Heart Center 
in order to design future community healrh 
education programs in Houston, Texas. On the 
basis of the survey, existing knowledge, atti- 
tudes, practices related to cardiovascular 
disease and its associated risk factors, as 
well as media habits of Houston area adults 18 
and older were evaluated. A random sample of 
2,322 subjects, including 69% Anglo, 23% 
Black, and 8% Mexican American was surveyed. 
Data revealed that a substantial portion cf 
the Mexican American community does not pos- 
sess fundamental knowledge necessary fcr 
adopting health risk reducing behaviors. In 
particular, there was little knowledge about 
cardiovasular disease. A need to supplement 
this information was identified. As a result, 
a community health information program was 
designed. Its purpose was to demonstrate the 
effectiveness of appropriate methods and 
media that increase awareness to the problers 
of high blood pressure among Mexican Americans 
in Houston, Texas. Based on the findings, it 
was concluded that stimulating high interest 
in target groups is a prerequisite to subse- 
quent adoptive behavior. In this sample, 
interest was a function of personal health 
experience and behavior which determined the 
importance and relevance of advocated behav- 
iors. When interest was high, corrective 
behavior was more likely when exposed to ap- 
propriate media and messages, such as the 
program designed for this target group. Re- 
ferences. 



54. Author: 
Title: 

Source : 
Abstract: 



Rosenbaum, M. , & Murphy, S. (1981). 
Getting the treatment: Recycling women ad- 
dicts. 

Journal of Psychoactive Drugs , 13(1), 1-13. 
In this ethnographic study differences experi- 
enced by women addicts in treatment are ex- 
amined. A sample of 100 women in San Francisco 
and New York City were interviewed, focusing 
on their drug-using careers. The interviews 
were voluntary and respondents were paid $2C. 
Interviews lasted two to three hours. The 
group was 43% White, 38% Black, 14% Latina, 



95 



and 5% other. Findings indicate that although 
the treatment goal is to eliminate the use of 
heroin this goal is seldom met. Problems 
encountered by the female heroin addict are 
limited space, inadequate facilities, physio- 
logical problems in relation to detoxification 
by methadone maintenance programs which lead 
to disillusionment, self -treatment , and a 
high rate of recidivism. 43 References. 



55. Author: 
Title: 
Source: 

Abstract: 



Rosenbaum, M. (1981) . 

Sex roles among deviants: The woman addict. 
The International Journal of the Addictions , 
16(5) , 859-877. 

This comparative study of the effect of sex 
roles on the careers of women addicts examines 
women committed to the California Rehabilita- 
tion Center for drug-related crimes. Data 
were gathered by means of guestionnaires and 
individual life histories. Each of the 180 
women was matched to a man with identical 
demographic characteristics. One half of the 
women were White, one fifth Chicana, and one 
fifth Black. The comparisons indicate that 78% 
of the women that had husbands who were ad- 
dicts, began using heroin later than men. 
Fifty percent started using after their 
spouses and only one third have shot heroin 
alone. Women had larger, more costly habits 
than men. White and Chicana women volunteered 
for treatment more often than men; however 
Black men and women had similar rates of volun- 
teering. Two thirds of the Chicana and 
White women had low self-concepts. Two thirds 
of Black women had high self-concepts. 
Women's self-image decreases as the size of 
the habit increases. Self-sufficiency and a 
manageable habit resulted in a high self- 
concept for women but not for men. 11 Refer- 
ences. 



56. Author: 
Title: 



Source: 
Abstract: 



Rosenbaum, M. (1981) . 

When drugs come into the picture, love flies 
out the window: Women addicts' love relation- 
ships. 

The International Journal of the Addictions , 
16 (7) , 1197-1206. 

This retrospective survey examines the rela- 
tionship between heroin use and love relation- 
ships. A sample of 100 female addicts (43% 
White, 38% Black, 14% Latino and 5% other) 
from New York and San Francisco was obtained 



96 



by posting notices in high drug use areas, the 
city prison and a variety of treatment 
facilities. The women were primarily active, 
non-institutionalized heroin users. The data 
was collected by in-depth interviews, personal 
histories and observations. Interviews were 
voluntary and usually lasted 2-3 hours. Find- 
ings suggest that female addicts had mates who 
were addicts or ex-addicts, that the heroin 
world was the communal ity shared, that the 
fixing routine and the sharing aspect of tak- 
ing heroin together replaced intercourse, that 
ultimately the relationship was undermined by 
conflicts over the heroin, and that the treat- 
ment of female addicts should focus on devel- 
oping job and career skills conducive to an 
independent life style rather than establish- 
ing traditional sex-role orientations. 6 Re- 
ferences. 



57. Author: 
Title: 

Source: 
Abstract: 



Rosenbaum, M. (1981) . 

Women addicts 1 experience of the heroin world: 
Risk, chaos, and inundation. 
Urban Life , 10 (1), 65-91. 

This ethnographic study looks at female heroin 
addicts, including their lifestyle, adjustment 
to risk and chaos, and the effects of risk and 
chaos on identity. The sample interviewed 
consisted of 100 female addicts (43 White, 38 
Black, 14 Latinas, 1 Asian, 1 Native American, 
and 3 Filipinas) . The age of the women ranged 
from 10 to 53 years with a median age of 28 
years. Of these, 34% were single, 23% were 
married, 24% divorced, 15% separated, and 4% 
widowed. The study consisted of interviews 
and personal histories and was conducted in 
New York and San Francisco. All interviews 
were voluntary and a $2 remuneration fee was 
paid each respondent. Findings indicate that 
the life of a female heroin addict is centered 
around the taking of heroin. The study com- 
pares male and female heroin activity and 
findings indicate that in women the risk as- 
pects lead to a lower status than in men. 54 
References. 



58. Author: 
Title: 
Source: 



Samet, J. M. , Skipper, B. J., Humble, C. G. , & 

Pathak, D. R. (1985) . 

Lung cancer risk and vitamin A consumption in 

New Mexico. 

American Review of Respiratory Disease , 131 

(2), 198-202. 



97 



Abstract: This paper reports on the association between 
dietary intake of vitamin A and lung cancer 
risk. A population-based, case control study 
of Hispanics and Anglos (477 patients and 759 
control subjects) was done in New Mexico. 
Data was collected through a food freguency 
interview which measured usual intake of total 
vitamin A retinal, preformed vitamin A, and 
carotene. Combining all respondents, the odds 
ratios for lung cancer were greater as intakes 
of total vitamin A and carotene declined, but 
did not vary with intake of performed vitamin 
A. Stratifying the subjects by ethnic group 
revealed that the significant effects of 
vitamin A consumption were limited to Anglos. 
While the protective effects of total vitamin 
A and carotene intake were present in men and 
women, they varied greatly with cigarette 
smoking habits. Only former smokers who had 
stopped smoking for 6 to 15 years showed 
significant effects of total vitamin A 
and carotene consumption. This limitation of 
the protective effect of vitamin A and 
carotene intake to past smokers has impor- 
tant implications for developing clinical 
trials and cancer control strategies. (Author 's 
abstract modified) . 



59. Author: 

Title: 

Source: 
Abstract: 



Samet, J. M. , Young, R. A., Morgan, M. V., & 
Humble, C. G. (1984) . 

Prevalence survey of respiratory abnormalities 
in New Mexico Uranium miners. 
Health Physics, 46 (2), 361-370. 
One-hundred-ninety-two miners in New Mexico 
with long-term (approximately ten years) ex- 
perience in uranium mines were given a preva- 
lence survey. 105 of the subjects were White 
Hispanic. Total duration of underground ura- 
nium mining was used as the exposure index. 
Hispanics were more likely to have never 
smoked, or to smoke less, than White non- 
Hispanics. Of the major respiratory symptoms, 
only the prevalenced dyspnea increased signi- 
ficantly with duration of uranium mining. 
Small, but statistically significant effects 
of mining were found for two spirometric mea- 
sures, the forced expiratory volume, and the 
maximal midexpiratory flow. Twelve of 143 
participants with x-rays available for inter- 
pretation had at least category 1/0 pneumo- 
coniosis. 3 5 References. 



98 



60. Author: 
Title: 
Source: 
Abstract: 



Samet, J. M. , Schrag, 



Howard, C. A. 



Key, C. R. , & Pathak, D. R. (1980). 
Respiratory disease in a New Mexico population 
sample of Hispanic and non-Hispanic Whites. 
Review of Respiratory Disease , 125 (2) , 152- 
157. 

To characterize the epidemiologic features of 
respiratory diseases among Hispanics a preva- 
lence empirical survey was conducted in Berna- 
lillo County, New Mexico. The ATS-DLD-78 res- 
piratory symptoms questionnaire was completed 
by 633 Hispanics and 1,038 Anglos with an 
overall response rate of 72%. Bilingual ques- 
tionnaires were initially mailed to subjects 
with Hispanic surnames. Three age groups were 
analyzed between Hispanic and Anglo female 
and male smokers: less than 40 years, 40-59 
years, and greater than or equal to 60 years. 
Anglo reported more physician-confirmed asth- 
ma, chronic bronchitis and/or emphysema than 
Hispanics. Anglos also reported more wheezing 
attacks with dyspnea, hay fever, and pneumo- 
nia. Adjusting for cigarette smoking status 
and age showed a similar smoking status in 
both groups, although more Anglo males over 
age 60 were ex-smokers. Hispanic males tended 
to use filter-tip cigarettes more often, 
while Anglo males smoked cigars and pipes more 
frequently. A greater number of Hispanic 
females age 40-59 years were lifelong smokers 
of filter-tip cigarettes than other female age 
groups. Current and cumulative cigarette 
consumption was significantly lower in Hispan- 
ics. A multiple logistic regression analysis 
revealed ethnicity as a predictor of dyspnea, 
with Hispanics exhibiting a greater prevalen- 
ce. Educational level was also a predictor 
of dypsnea. A significant predictor of respi- 
ratory disease was lifelong smoking consump- 
tion. Present smokers exhibited a persistent 
wheeze and chronic cough and phlegm. Ethnicity 
had an effect on the occurrence of physician- 
diagnosed asthma, with a greater risk to An- 
glos. Risk factors for physician-confirmed 
chronic bronchitis and/or emphysema included 
cigarette consumption, age, and female sex. 
These data demonstrate differences in the epi- 
demiologic features of respiratory disease 
among the Hispanic and Anglo populations in 
New Mexico. Many of the differences resulted 
from lower cigarette consumption by the 
Hispanics. The extent to which these results 
can be generalized to other Hispanic popula- 
tions is unclear. 32 References. 



99 



61. Author: 
Title: 



Source: 
Abstract: 



Siantz, M. L. (1984) . 

The effect of stress on maternal depression 
and acceptance/rejection of Mexican migrant 
mothers . 

Ann Arbor, MI: University Microfilms 
International No. Pending. 

This empirical study sought to determine if 
response to problems in life conditions varied 
in the presence of total social supports. 
Responses to problematic conditions included 
depression and maternal acceptance/rejection. 
One hundred Mexican migrant mothers of pre- 
schoolers were interviewed for this study 
through the Texas Migrant Council's Headstart 
program. Instruments used were the Invent ory 
for Socially Supported Behaviors (Barrera, 
1983) , the Stress and Support Family Function- 
ing Interview (Colletta, 1981) , the Center fcr 
Epidemiologic Studies Depression Scale (Raa- 
loff , 1979) , and Parental Acceptance-Rejection 
Questionnaire (Rohner, 1975) . Factors thought 
to affect the relationship between problems of 
life conditions and the dependent variables 
were entered into multiple regression 
analysis. Total social supports accounted fcr 
75% of the explained variance in maternal 
acceptance/rejection in the presence of de- 
pression. To explain why social supports did 
not account for variance in depression, prob- 
lems with reliability and methodology were 
ruled out. Total task support, a subcategory 
of total social support, with the most vari- 
ance was disaggregated into kinds of task 
support through a factor analysis having a 
verimax rotation. A Pearson Moment correla- 
tion was done to identify if any statistical 
relationship existed between these factors 
and the dependent variables. It was concluded 
that in the presence of child care support, 
migrant mothers are less likely to become 
depressed and are warmer toward their child- 
ren. If a mother's problems are not taken 
seriously, they are more likely to become 
depressed. When mothers can share their pri- 
vate feelings and be distracted from their 
problems, they are less likely to neglect 
their children. If mothers are provided tan- 
gible assistance, they are more likely to be 
accepting of their children. 222 References. 



62. Author: 



Staff. (1981). 



100 



Title: Use of lead tetroxide as a folk remedy for 
gastrointestinal illness. 

Source: U.S. Department of Health and Human Services, 
PHS, Morbidity and Mortality Weekly Report , 30 
(43) , 546-547. 

Abstract: The purpose of this article is to discuss the 
use of Azarcon as a folk remedy for gastro- 
intestinal illness among Hispanics. Azarcon 
is a lead tetroxide with a total lead content 
of 86%. The distribution of this substance as 
a cure for gastrointestinal illness is of 
great concern. It is recommended that author- 
ities in areas with Hispanic populations 
should be aware of this potential health ha- 
zard. Parents are often reluctant to admit the 
use of folk remedies, especially to physi- 
cians. Children with lead poisoning are usual- 
ly asymptomatic, or have non-specific symp- 
toms. Because of this and the estimated high 
prevalence rates of the disease, the Center 
for Disease Control recommends that all chil- 
dren 1 to 5 be screened for lead toxicity. 
Medical examiners should consider lead ex- 
posure when examining young children. Re- 
ferences. 



63. Author: 

Title: 
Source: 

Abstract: 



Stern, M. , Haffner, S., Hazuda, H. & Rosenthal, 
M. (1984, December) . 

Cadiovascular disease in Mexican Americans . 
Paper presented at The Woodlands Conference 
on Chronic Diseases Among Mexican Americans. 
Data from large scale epidemiological health 
studies conducted with Mexican American sam- 
ples are reviewed in an effort to explain the 
low cardiovascular mortality rate found within 
this population. Numerous cardiovascular risk 
factor studies suggest that most risk factors 
are the same or worse among Mexican Americans 
than Anglo Americans. The authors suggest 
that the cardiovascular risk factor pattern of 
Mexican Americans is hard to reconcile with 
the lower rate of cardiovascular mortality 
found for males. Also difficult to explain is 
the lower male-to-female ratio in cardiovas- 
cular mortality in Mexican Americans compared 
to Anglo Americans. The authors conclude that 
additional research is needed to examine whe- 
ther conventional cardiovascular risk factors 
have the same impact on cardiovascular disease 
in Mexican Americans as in their Anglo Ameri- 
can counterparts. 28 References. 



101 



64. Author: 



Title: 



Source: 
Abstract: 



Stern, M.P., Gaskill, S. P., Allen, Jr., C.R., 
Garza, V., Gonzales, J.L., & Waldrop, R. H. 
(1981) . 

Cardiovascular risk factors in Mexican Ameri- 
cans in Laredo, Texas. I. Prevalence of over- 
weight and diabetes and distribution cf serum 
lipids. 

American Journal of Epidemiology , 113 (5) , 546- 
555. 

The purpose of this study was to investigate 
the distribution of cardiovascular risk fac- 
tors in a low-income, Mexican American popula- 
tion living in Laredo, Texas. The prevalence 
of overweight and diabetes and the 
distribution of plasma lipid concentrations 
were also presented. A randomized sample of 
389 subjects from two low- income, almost ex- 
clusively Mexican American census tracts were 
chosen. The sample included 127 men and 2 62 
women. The subjects were administered a brief 
questionnaire concerning prior diagnosis of 
diabetes during a home visit and blood pres- 
sures were taken three times. Appointments 
were then given for repeat blood pressure 
measurement and fasting blood work at the 
Health Department. The prevalence for over- 
weight was determined according to criteria 
developed in the Health and Nutrition Examina- 
tion Survey (HANES I) . The prevalence of 
overweight in Laredo was compared with the 
national estimate from HANES I and with the 
rates reported for Pima Indians. The preva- 
lence of overweight was found to be interme- 
diate between U.S. national estimates and the 
rates recorded for Pima Indians. Fasting 
hyperglycemia was intermediate between the 
rates observed in the sample of predominantly 
Caucasian individuals and those observed in 
Pima Indians. Excess hyperglycemia in the 
Laredo Mexican American population compared to 
a predominantly Caucasian population does not 
reflect a lower level of medical control of 
diabetes in the study population, but a true 
excess in the prevalence of diabetes. Serum 
cholesterol and triglyceride concentrations 
were also higher in the sample than in a 
Caucasian comparison population. This may be 
due to the fact that Mexican Americans are of 
mixed European and Native American ancestry. 
Native Americans have high rates of diabetes 
which could be genetically determined. On the 
other hand, sociocultural determinants could 
also need consideration since they are 
thought to influence obesity, a major precur- 



102 



sor to diabetes. 28 References, 



65. Author: 



Title: 



Source: 
Abstract: 



Stern, M. P., Relethford, R. E., Ferrell, R. , 
Gaskill, S. P., Hazuda, H. P., Haffner, S. M. , 
& Gardner, L. I. (1982) . 

Diabetes and genetic admixture in Mexican 
Americans: The San Antonio Heart Study. 
Diabetes, 31(Suppl. 2), 45A. 

The prevalence of diabetes was determined in 
963 randomly selected Mexican Americans: 4 69 
from a low income barrio, 178 from a middle 
income transitional neighborhood, and 276 from 
a high income suburb. There was a marked de- 
cline in the prevalence of diabetes from 
barrio to suburb, ranging in men from 15.7% in 
the barrio to 6.9% in the suburb. The women 
ranged from 18.3% in the barrio to 1.4% in the 
suburb. It was suggested that in addition to 
the sociocultural factors mediated by obesity, 
the amount of Native American admixture 
might also play a role in increased diabetes 
in the Mexican American communities. Native 
American admixture was estimated by using skin 
color as measured by a reflectance meter and 
previously validated model and by using gene 
frequencies at eight blood group loci. The 
studies indicate that diabetes prevalence 
decreases as Native American admixture de- 
creases, suggesting a genetic component to 
diabetes in Mexican Americans. Abstract. 



66. Author: 
Title: 



Source: 
Abstract: 



Stern, M. P., Gaskill, S. P., Hazuda, H. P., 
Gardner, L. I., & Haffner, S. M. (1983). 
Does obesity explain excess prevalence of dia- 
betes among Mexican Americans? Results of the 
San Anotnio Heart Study. 
Diabetologia , 24, 272-277. 

The purpose of this study was to determine 
if the excess rate of Type II diabetes in 
Mexican Americans could be entirely attributed 
to their high prevalence of obesity or whether 
other factors such as genetics or nutrition 
explain the overweight. Genetic susceptibility 
was considered due to the mixed ancestry of 
Mexican Americans that includes both Native 
Americans and European ancestry. Native 
Americans have a genetic predisposition to 
Type II diabetes which Mexican Americans could 
share. Nine hundred and thirty-six Mexican 
Americans and 398 Anglo Americans were random- 
ly selected from three socially and culturally 
distinct neighborhoods in San Antonio, Texas. 



103 



Obesity categories included: lean, average, 
and obese based on skin-fold measurements. 
Mexican Americans were two to four times as 
likely to fall into the obese category as 
Anglo Americans. Within the categories, 
two ethnic groups were closely matched in 
terms of sum of skinfolds. The prevalence of 
Type II diabetes was significantly greater in 
Mexican Americans than Anglo Americans, even 
when comparisons were made within the three 
obesity categories. The summary prevalence 
ratio when obesity was controlled was found to 
be 2.54 (p = 0.004) for males and 1.70 (p = 
0.036) for females. This indicated that lean 
Mexican Americans were still at greater risk 
for Type II diabetes than equally lean Anglo 
Americans. In addition, while Type II diabetes 
risk increases with obesity, obese Anglo 
Americans are somewhat protected when compared 
with equally obese Mexicans. Plasma glucose 
was found to be significantly higher in Mexi- 
can Americans than in Anglo Americans, even 
when obesity was controlled. This finding 
indicated that while obesity contributes to 
Type II diabetes among Mexican Americans, it 
does not alone explain the entire excess pre- 
valence rate. 18 References. 



67. Author: 
Title: 

Source: 
Abstract: 



Stern, M. P., Pugh, J. A., Gaskill, S. P., 
& Hazuda, H. P. (1984) . 

Knowledge, attitudes, and behavior related to 
obesity and dieting in Mexican Americans and 
Anglos: The San Antonio Heart Study. 
American Journal of Epidemiology , 115 (6) , 917- 
927. 

The San Antonio Heart Study is a comprehensive 
epidemiologic investigation of life styles as 
they relate to obesity, diabetes, and cardio- 
vascular risk factors in Mexican Americans 
and Anglos living in San Antonio, Texas. The 
study is designed to clarify the extent to 
which ethnic differences in these health vari- 
ables are due to life style factors as opposed 
to genetic factors. The purpose of the study 
reported in this article is to present data on 
knowledge, attitudes, and behavior related to 
obesity and dieting on an initial group of 
participants representing both ethnic groups 
and two levels of social class. Two socio- 
economically and culturally distinct target 
areas in San Antonio were used in the sample. 
These included a middle-income ethnically 
integrated area (transitional) and an upper- 



104 



income predominantly Anglo area (suburbs) . 
Two behavioral scales were created: the 
"sugar avoidance" scale and the "dieting" 
behavior scale. Pearson and Spearman 
correlation coefficients between relative 
weight and the various dependent variables 
were calculated. Statistical analysis was 
done using the Biomedical Computer Programs 
(BMDP) . The results showed that while subur- 
banite Mexican Americans were leaner than 
their lower-income counterparts, they were 
still more overweight than suburbanite Anglos. 
Even after adjusting for these differences in 
relative weight, Mexican Americans were more 
likely than Anglos to communicate that Ameri- 
cans are overly concerned about weight loss. 
Mexican American women in transitional neigh- 
borhoods in particular were less concerned 
about weight. While no ethnic differences in 
the two behavioral scales were found in the 
more affluent suburbs, the implications for 
public health concern in general was ascer- 
tained since the majority of Mexican Americans 
in the United States are of low socioeconomic 
status. 23 References. 



68. Author: 
Title: 

Source: 
Abstract: 



Rosenthal, M. 



Haffner, S. M. 



Stern, M. P. 
Hazuda, H. P. , & Franco, L. J. (1984). 
Sex difference in the effects of sociocultural 
status on diabetes and cardiovascular risk 
factors in Mexican Americans: The San Antonio 
Heart Study. 

The American Journal of Epidemiology , 120 (6) , 
834-851. 

It is hypothesized that as Mexican Americans 
became more affluent and/or acculturated to 
"mainstream" United States life-style they 
will progressively lose their "obesity-related" 
pattern of cardiovascular risk factors which 
were defined as: obesity, diabetes, hypertri- 
glyceridemia and low levels of high-density 
lipoprotein cholestrol. This hypothesis was 
tested in 1979-1982 in the San Antonio Heart 
Study, which is a population-based study of 
1,288 Mexican Americans and 929 Anglos living 
in three San Antonio neighborhoods: a low 
income barrio, a middle-income transitional 
neighborhood, and a high income suburb. The 
study population comprised 25 to 65-year-old 
men and non-pregnant women. In Mexican 
American women, all the "obesity-related" risk 
factors fell sharply with rising socioeconomic 
status. In Mexican American men by contrast, 



105 



diabetes was the only "obesity related" risk 
factor which fell with rising socioeconomic 
status. Moreover, it fell less steeply, there 
being an approximately twofold difference in 
diabetes prevalence between the barrio and 
the suburbs in men compared to a fourfold 
difference in women. Also, total and low- 
density lipoprotein cholesterol rose with 
rising socioeconomic status in Mexican Ameri- 
can men, but not in Mexican American women. 
"Obesity-related" risk factors were generally 
higher in Mexican Americans of both sexes than 
in their Anglo neighbors who were of similar 
socioeconomic status. These results suggest 
that cultural factors exert a stronger influ- 
ence on diabetes and cardiovascular risk fac- 
tors in Mexican Americans than do purely so- 
cioeconomic factors. 3 3 References. 



69. Author: 



Title: 



Source: 
Abstract: 



Texas Migrant Council, Inc. , & Minority Resour- 
ce Center on Child Abuse and Neglect for 
Mexican Americans (1982) . 

A study of attitudes toward child abuse and 
child rearing among Mexican American migrants 
in Texas . 

Laredo, Texas: Texas Migrant Council, Inc. 
Three major goals underlie this study: 1) to 
provide a descriptive profile of migrants with 
young children, 2) to investigate the migrants' 
attitude toward child rearing, and 3) to exa- 
mine attitudes towards child abuse. A total 
of 500 Mexican American parents utilizing Head 
Start programs in Texas were interviewed in 
six general areas: migrant lifestyle, educa- 
tion of the child, socialization, childrearing 
practices, attitudes toward child abuse and 
neglect issues, and awareness and usage of 
social services and child protective services. 
Analyses are presented in percentages provid- 
ing information on the demographic profile 
and attitudes toward childrearing and child 
abuse. Not surprisingly, demographic results 
depict the Mexican American migrants as poor, 
low-skilled individuals with large extended 
families, and with low levels of education and 
low mobility outside of their migration pat- 
terns. Respondents' childrearing patterns 
tend to follow those of their parents and 
their interaction with their offspring is 
limited. A variety of rewards and punishments 
are used with the children and obedience is 
considered an important lesson for children to 
learn. There is low tolerance for abuse and 



106 



neglect, although if it goes on in the commu- 
nity, it tends not to be reported. Socioeco- 
nomic status and education did not appear to 
be related to tolerance of abuse and neglect. 
In comparison to the general population of 
Texas, the migrants' attitudes toward abuse 
and neglect represent less willingness to 
tolerate such practices than those of the 
general population. It is concluded that 
more work needs to be done in this area. 6 
References. 



7 . Author : 
Title: 

Source: 
Abstract: 



Tulloch, B.R. , Hanis, C. , & Schull, W.J. (1982) 
Homo diabeticus Rio Grande: Epidemiology in 
Starr County, Texas. 
Diabetes, 31 (Suppl. 2) , 45A. 

Review of diabetic mortality in Texas revealed 
a death rate of 3.1 to 64.5 per 1,000, with 
the higher rates occurring in counties with 
80% Spanish origin population. A National 
Institutes of Health supported study was con- 
ducted to assess the prevalence of diabetes in 
the adult Mexican American population. A 
random sample of 2,445 people over 14 years of 
age was selected in Starr County, Texas (98% 
Mexican American) . Histories taken indicated 
that rates for males were: 17-44 years, 2.3%; 
45-64, 10.7%; and over 64, 12.6%. Rates for 
women were: 17-44 years, 1.2% 
and 13.1% for females over 64. 
prevalence rates when compared 
tional Commission on Diabetes 
suggest that women between 17 and 44 and over 
64 years of age are substantially at higher 
risk. (Journal abstract modified) . 



45-64, 14.0%; 

Age and sex 

with the Na- 

Report (1976) 



7 1 . Author : 

Title: 

Source: 
Abstract: 



Ueno, Y., Iwaki, Y., Terasaki, P. I., Park, M.S., 
Barnett, E. V., Chia, D. , & Nakata, S. (1981). 
HLA-DR4 in Negro and Mexican rheumatoid arthri- 
tis patients. 

The Journal of Rheumatology , 8_(5) , 804-807. 
The purpose of this research was to determine 
whether rheumatoid arthritis patients of other 
races have a higher incidence of DR-4 or pos- 
sibly a different antigen. HLA-DR antigen 
was tested in 38 Caucasians, 18 Negro, 17 
Mexican and 5 Japanese patients with rheuma- 
toid arthritis. HLA-A, -B, -C and DR lympho- 
cyte alloantigens were tested by the standard 
microcytotoxicity test. Coefficients of link- 
age disequalibrium (>) were obtained. Signi- 
ficantly high HLA-DR4 were observed in all 



107 



races. This included 61% for Caucasians, 39% 
for Negroes, 77% for Mexicans, and 100% for 
Japanese. No clinical correlations with the 
DR4 antigen were found. This may indicate 
that the clinical features are not specifical- 
ly related to the genetic susceptibility fact- 
or, but are instead features in the pro- 
gression of the disease. 17 References. 



72. Author: 
Title: 



Source: 
Abstract: 



Van den Tweel, J. G. , Dugas, D.J., Loon, J., & 
Lukes, R. J. (1982) . 

HLA typing in non-Hodgkins lymphomas: Compara- 
tive study in Caucasoids, Mexican Americans 
and Negroids. 

Tissue Antigens, 20 , 364-371. 

The purpose of this study was to examine 
whether an association between HLA and the 
functional subgroups of non-Hodgkin' s lymph- 
omas could be detected. Over 200 cases of 
non-Hodgkin 1 s B, C, and DR antigens was typed 
for HLA-A, B, C, and DR antigens. Typing 
was correlated with morphologic diagnosis 
according to the Lukes-Collins classification 
system of non-Hodgkin 1 s lymphomas. The major 
racial groups represented were Caucasian, 
Mexican and Negroid. Significant associations 
were between HLA-AW33 and Caucasoid B-cell 
lymphomas, and for HLA-AW24, HLA-B37 and HLA- 
B4 and B cell lymphomas in Negroids. No 
significant correlations were found within the 
Mexican American population. The number of T 
cell lymphomas was not enough to make any 
conclusions. The DR antigens were not signi- 
ficantly associated with any of the diagnostic 
subgroups. 17 References. 



7 3 . Author : 
Title: 
Source: 
Abstract: 



Weiss, K. M. , Ferrell, R. E., Hanis, C. L. , & 
Styne, P. N. (1984) . 

Genetics and epidemiology of gallbladder di- 
sease in New World native peoples. 
American Journal of Human Genetics , 36 1259- 
1278. 

In most populations of the world, the rise in 
gallbladder disease has resulted from "west- 
ernization, "including consumption of high- 
calorie, high-fat, low-fiber and insufficient 
excercise. Gallbladder disease rates are 
very high among persons of Amerindian descent, 
suggesting a genetic linkage. Studies were 
conducted in Laredo and Starr County in South 
Texas. The Laredo study focused on 42,8 64 
hospital in-patient discharge records for the 



108 



years 1910-1945, and cholecystectomy records 
for 1980. The Starr County study (97.7% Mexi- 
can American) was a household survey of 10% of 
the county, yielding 617 male and 1,050 female 
respondents. Data from the study show that 
the risk that a genotypically susceptible 
Mexican American female will undergo a chole- 
cystectomy by age 85 can approach 40%, and the 
risk of gallbladder cancer can reach about 3% 
percent. A genetic susceptibility may be as 
"carcinogenic" in New World people as a known 
environmental. Data showing gallbladder cancer 
rates for other Latin American nationalities 
and American groups are also given for compar- 
ison. 92 References. 



74. Author: 
Title: 

Source: 

Abstract: 



Zavaleta, A. N. & Malina, R. M. (1980). 
Growth, fatness, and leaness in Mexican Ameri- 
can children. 

The American Journal of Clinical Nutrition , 
33 , 2008-2020. 

A sample of 1,269 Spanish-surnamed children 
(619 boys and 650 girls, age 6 through 17 
years) was taken in Brownsville, Texas. These 
are almost exclusively Mexican-origin children. 
The families were from schools located in 
areas classified as lower socioeconomic. 
Height, weight, arm circumference, and triceps 
skin fold were measured. The arm circumfer- 
ence was corrected for triceps skinfold to 
estimate midarm muscularity and fatness. The 
triceps skinfold was also used to estimate 
obesity and leanness. The heights and weights 
of the sample are comparable for other Mexican 
American samples, but fall at about the 2 5th 
percentile of the nationally based Health 
Examination Survey (HES) . Compared to the na- 
tional norm, there is less muscle mass in the 
midarm areas for the sample than national 
norms, suggesting a correlation with a diet 
that is sufficient in calories, but low in 
protein. This lessened muscle mass may also 
reflect the generally smaller stature of 
Mexican American children. The rate of obesi- 
ty is about the same for Mexican girls as in 
the HES sample, but the rate for Mexican 
American boys is about twice that of the na- 
tional sample. 34 References. 



75. Author: 
Title: 



Ziedler, A., Frasier, S. D. , 
Loon, J. (1982) . 
Histocompatibility antigens and 



Kumar, D. , & 
immunoglobu- 



109 



lin G insulin antibodies in Mexican American 
insulin-dependent diabetic patients. 

Source: Journal of Clinical Endocrinology and Metabo- 
lism, 54 (4), 569-573. 

Abstract: A study of the associational histocompatibili- 
ty antigens (HLA) with insulin-dependent: 
diabetes (IDD) in Mexican Americans. The 
sample is persons born in Mexico, or first 
generation born in the U. S. of Mexican- 
born parents. 112 such persons, using an 
outpatient diabetic clinic in Los Angeles, 
diagnosed as having IDD, were typed for HLA-A, 
-B, and -C. An additional typing for HLA-DR 
was performed on 85 persons of this sample. 
Controls for the first typing were 332 and for 
the second, 209. IDD patients have a signifi- 
cant increase in HLA-DR4 compared to the con- 
trol population. HLA-DR2 was not detected in 
any IDD patient. There was a significant 
association between HLA-AW3 and HLA-B18 in 
IDD patients as to the controls. IgG insulin 
antibody formation was increased in HLA-DR3- 
and DR4-negative patients compared to that in 
patients positive for both antigens. The find- 
ings support observations in Caucasian and 
Black Americans and indicate that HLA-DR 
specificities are associated with IDD and may 
play a role in determining its mode of inheri- 
tance, and perhaps of its pathogenesis, inde- 
pendent of ethnic difference. 29 References. 



76. Author: 
Title: 

Source: 
Abstract: 



Ziedler, A., Fraser, S.D., Penny, R. , Stein, R. 
B., & Niciloff, J. T. (1982). 

Pancreatic islet cell and thyroid antibodies, 
and islet cell function in diabetic patients 
of Mexican American origin. 

Journal of Clinical Endocrinology and Metabo- 
lism , 54(6), 949-954. 

A study of the presence of pancreatic islet 
cell antibodies (ICA) and thyroid microsomal 
antibodies (TMA) in Mexican American patients. 
The study group of 236 diabetic persons was 
taken from patients utilizing a diabetes 
clinic in Los Angeles. 131 subjects were 
insulin-dependent diabetics (IDD) and 105 
were non-insulin dependents (NIDD) . A 
control group of 79 normal subjects was used. 
In the Mexican American IDD patients, the 
prevalence of ICA and TMA is lower than in a 
similar Caucasian population in Europe or the 
U.S. The persistence of ICC in IDD patients is 
related to the duration of the disease. The 
presence of ICA is not related to pancreatic 



110 



islet cell functions, as C- peptide levels 
were found to be similar in IDD patients with 
and without ICA. The suggested lower fre- 
quencies of ICA and TMA in Mexican American 
IDD can be explained by a reduced 
susceptibility to organ-specific autoimmunity 
in this popula tion. This may indicate ethnic 
differences and heterogeneity in IDD popula- 
tions. 3 6 References. 



ill 



Clinical & Scientific 
Studies 



113 



77. Author: Abeyta-Benke, M. A. (1981). 

Title: A nutrition profile of the Hispanic elderly. 

Source: In P. Vivo & C. D. Votaw (Eds.), The Hispanic 
Elderly : La Fuente de Nuestra Historia, 
Cultura Y Carino (pp. 114-120) . Rockville, MD: 
U. S. Department of Health and Human Services, 
Public Health Service (Spanish Heritage Public 
Health Service Workers) . 

Abstract: The author presents a nutrition profile of the 
Hispanic elderly and at the same time draws 
our attention towards avoiding stereotyping 
the nutrient needs of the elderly. Eighty 
percent of the general elderly Hispanic pop- 
ulation is characterized by one or more 
chronic diseases which may result in secondary 
malnutrition if untreated. Natural changes 
occuring with age mandate a qualitative change 
in nutrients due to changes in lifestyle, 
socioeconomic status, psychological changes 
and the presence of chronic diseases which 
alter nutrient intake. Recommendations of 
nutrient needs are tentative and based on 
current understanding of the natural physio- 
logical changes occuring with the aging pro- 
cess such as decreased renal function, 
nutrient-drug interaction, gastrointestinal 
changes, skeletal changes, increased blood 
pressure, neuromuscular changes, deteriorating 
vision, decline in muscular strength, and 
gradual reduction in performance of many organ 
systems. Aging and physiological changes 
associated with it are highly individual. 
Among different people, aging occurs at dif- 
ferent rates and time, but through adequate 
nutrition the integrity of renewable cells 
and the preservation of the integrity of non- 
renewable cells may be achieved thereby reduc- 
ing the rate of aging. References. 



78 



Author : 
Title: 



Source; 



Abstract: 



Adelman, J. D. (1983) . 

Staff awareness of Hispanic health beliefs 
that affect patient compliance with cancer 
treatment . 

In Progress in Cancer Control III: A Regional 
Approach . (pp. 85-86). New York: Alan R. Liss, 
Inc. 

The Columbia University Division of Cancer 
Control is developing a unique approach for 
improving the compliance with clinic appoint- 
ment for chemotherapy of Hispanic patients. 
They are developing open-ended standardized 
interviews to be administered to Dominicans, 
Puerto Ricans and Cubans in either Spanish or 



115 



English to ascertain culturally derived 
beliefs and behaviors about compliance and 
noncompliance with chemotherapy treatment. 
These culturally derived beliefs and behav- 
iors, together with the sociodemographics of 
these patterns, will be identified, compared, 
and analyzed. These patterns of behavior and 
attitudes will then be incorporated into 
training sessions with the health care staff 
to improve clinician/patient relationships. 
Patient compliance rates before and after this 
program will be compared. References. 



79. Author: Arfaa, F. (1981). 

Title: Intestinal parasites among Indochinese refu- 
gees and Mexican immigrants resettled in 
Contra Costa County, California. 

Source: The Journal of Family Practice , 12 (2) , 223- 
22 6. 

Abstract: Stool samples of 186 Indochinese refugees and 
99 immigrants from Mexico, all of whom had 
been referred by physicians to the Public 
Health laboratory of Contra Costa County, were 
examined. Rates of infection varied with age 
and sex. The Indochinese had an overall 
infection rate with one or more parasite (s) of 
60%, with a rate of 80% in the age of 10-14 
group. Infection rates were much lower 
overall in the Mexican group, at 39%. Among 
the Mexican group specific parasites and 
rates were: whipworm, 12%; Ascaris, 12% 
Giardia lamblia, 11%; dwarf tapeworm, 9%; 
Entamoeba histolyica, 4%; hookworm 2% Strog- 
loides, 1%. 9 References. 



80. Author: Banker, C.A., Berlocher, W.C., & Mueller, B. H. 

(1984) . 

Title: Primary dental arch characteristics of Mexican 
American children. 

Source: Journal of Dentistry for Children , (May-June) , 
200- 212. 

Abstract: To gain baseline information on the primary 
dentition of Mexican American surname children 
36-60 months were examined. Maxillary and 
manibular alginate impressions and centric 
occulusion waxbite registrations were taken. 
The main arch configuration found among the 
children was ovoid, overbite ranged from 2 to 
5 mm and an over jet of 0-2 mm was found fre- 
quently. The maxilla had a higher percentage 
of primate and generalized space than the 
mandible. Class I canine relationship was 



116 



present and the majority of children exhibited 
a straight second molar terminal plane rela- 
tionship. 14 references. 



81. Author: Baranowski, T. , Bee, D. E. , Rassin, D. K. , 

Richardsen, C. J., Brown, J. P., Guenthur, N. , 
& Nader, P. R. (1983) . 

Title: Social support, social influence, ethnicity, 
and the breastfeeding decision. 

Source: Social Science and Medicine 17(21), 1599-1611. 

Abstract: The purpose of this study was threefold: 1) 
to establish whether the decision to breast- 
feed was related to the social support re- 
ceived for breastfeeding, 2) to determine 
which individual or combination of individuals 
providing support were most influential in 
promoting breastfeeding, and 3) to ascertain 
if a difference existed between social 
influence and social support processes. In 
order to answer these questions, a survey was 
conducted of all mothers delivering infants at 
a medical center hospital in Galveston, 
Texas. The survey was conducted within 4 8 
hours of delivery during the month of July 
1981. An instrument which included questions 
on the decision to breastfeed, social support, 
and social influence was utilized. A chi- 
square test for independence was used to study 
the relationship of decision to demographic, 
social support, and social influence vari- 
ables. The pattern of bivariate relationships 
between person's supportiveness and breast- 
feeding varied across ethnic and marital sta- 
tus groups. Single and multiple logistic 
analyses were also conducted in order to 
determine who was most supportive of initiat- 
ing breastfeeding. It was found that among 
Black Americans, a close friend was the most 
important source of support. For Mexican 
Americans, support from one's mother was the 
most important social support variable. With 
Anglo Americans, the male partner's support 
was the most valued. It was concluded that 
the key person to reach in order to increase 
support for breast feeding varies among ethnic 
groups. Therefore programs aimed at increas- 
ing Anglo American breastfeeding behavior 
should include male partners. For Black Amer- 
icans, including friends is important. On 
other hand, among Mexican American mothers, 
social supportive targets ought to include 
the physician, mother of the index mother, 
friend, and grandmother in that order. 4 3 



117 



references. 



82. Author: 

Title: 

Source: 

Abstract: 



Barnett, P. G., Midtling, J. E., Velasco, A. 
R. Romero, P., O'Malley, M. Clements, C. , 
Tobin, M. W. , Wollitzer, A. 0., & Barbaccia, 
J. R. (1984) . 

Educational intervention to prevent pesticide- 
induced illness of field workers. 
The Journal of Family Practice , 19 (1) , 123- 
125. 

In response to a lack of knowledge regarding 
the potential health threat of working with 
pesticides among migrant Mexican field 
workers, a project was initiated to meet the 
health educational needs of these farm 
workers. Methodology included the development 
of a slide show with recorded narration 
featuring an interview with a member of a 
poisoned crew and its presentation to 16 
groups of farm workers, students in adult 
English classes, parent advisory committees to 
migrant education programs, those attending 
meetings at a migrant labor camp, and parents 
at a community farm workers' clinc. The sample 
included 566 people. Of these, 166 agricul- 
tural workers were interviewed with a 
multiple-choice survey instrument in Spanish. 
Pre- and post-tests were given. Those 
surveyed before the presentation gave an 
average of 10.2 correct answers to the 14 
questions asked in the questionnaire. Those 
surveyed immediately after gave an average of 
11.6 correct answers. A third group was fol- 
lowed up after the presentation and averaged 
11.3 correct responses. An analysis of the 
variance and Scheffe comparison showed the 
mean score of the post-test group to be signi- 
ficantly greater than the pre-test group. 
A striking observation was that after every 
educational presentation, someone in the 
audience volunteered an anecdote of past expo- 
sure to pesticide and resultant illness. The 
slide show augmented knowledge of pesticides. 
Because of the attention focused on this 
public health program, Monterey County became 
the first agricultural area in the United 
States to require that warning signs be posted 
in fields of pesticide-treated vegetable 
crops. 3 References. 



8 3 . Author : 



Black, J. 
F. (1982) . 



Cahalin, C, 



& Germain, B. 



118 



Title: Pedal morbidity in rheumatic diseases: A 
clinical study. 

Source: Journal of the American Podiatry Association , 
72(7), 360-362. 

Abstract: The purpose of this clinical investigation was 
to identify the pedal morbidity in a general 
rheumatic disease clinic. One hundred patients 
were sequentially selected over a six-week 
period from a general rheumatic disease clinic 
at the Veterans Administration Hospital in 
Tampa, Florida. Ninety-five percent of the 
subjects were male with an age range of early 
20 's to late 70 's. Ninety-four percent were 
Caucasian, 3% Hispanic, and 3% Black. Disease 
entities were identified within the survey 
pool. The incidence of pedal morbidity in the 
cross section of rheumatic diseases was 82%. 
Seven of the 17 identified rheumatic diseases 
presented pedal morbidity at a 90% level or 
greater. It was concluded that patients with 
rheumatic diseases are at high risk for pedal 
morbidity. Therefore, in the management of 
the needs of patients with rheumatic diseases, 
the medical team needs to focus on this hidden 
part of the body. In this sample, rheumatoid 
arthritis was the most common rheumatic dis- 
ease. 15 References. 



Vashista, K. , & O'Loughlin, B. J, 



cause of lead 



three 
given 



84. Author: Bose, A. 

(1983) . 

Title: Azarcon por empacho — another 
toxicity. 

Source: Pediatrics , 72_(1) , 106-108. 

Abstract: This study consisted of case reports of 
Mexican American children who had been 
azarcon, a folk remedy containing 86 to 95% 
lead. The treatment was to cure indigestion 
or any digestive symptoms known as empacho. 
Notes on the beliefs about empacho, inclu- 
ding causes and cures are given. For example, 
Azafran, another orange folk remedy for 
empacho, is largely American Saffron and is 
harmless. However, greta, another remedy for 
empacho contains a mercury derivative that can 
also be harmful. 9 References. 



85. Author: 
Title: 

Source: 
Abstract: 



Brandt, Jr., E. N. , & McGinnis, J. M. (1984). 
Nutrition monitoring and research in the 
Department of Health and Human Services. 
Public Health Reports , 99(6), 544-549. 
This paper is based on the testimony of 
Dr. Edward N. Brandt, Assistant Secretary for 



119 



Health before the Subcom- 

mittee on Science, Research and Technology. 
The paper reviews the status of current nutri- 
tion research and monitoring describing ele- 
ments of activity and progress central to both 
nutrition monitoring and human nutrition re- 
search. In particular this report highlights 
a special survey of the health and nutritonal 
status of Hispanics. Data for this project 
was completed in 1984. The Public Health 
Service plans to release the first data tapes 
for analysis on the Mexican American sample in 
December, 1984. The policy implications for 
human nutrition within the Department of 
Health and Human Services is also highlighted. 
References. 



86. Author: Brinton, L. A., Hoover, R. , Jocobson, R. R. , & 

Fraumeneni, Jr., F. (1984). 

Title: Cancer mortality among patients with Hansen's 
disease. 

Source: Journal of National Cancer Institute , 72 (1) , 
109-114. 

Abstract: For the evaluation of cancer risks associated 
with immunodeficiencies experienced by pa- 
tients with Hansen's disease (Leprosy) and for 
the assessment of possible adverse effects of 
dapsone therapy, a follow-up study was conduc- 
ted of 1,678 patients admitted to the National 
Hansen's Disease Center in Carville, LA, be- 
tween 1939 and 1977. A total of 709 Hispanics 
most of whom were of Mexican descent were 
included in the follow-up study. To obtain 
expected mortality for the Hispanic sample, 
actual mortality rates for New Mexico Hispan- 
ics were used. Overall, no substantial cancer 
mortality was observed (standard and mortality 
ratio=1.3) nor was there any excess among 
patients exhibiting defects in cellular immu- 
nity by virtue of Lepromatous forms of the 
disease. Notable was the absence of any sig- 
nificant excess of lymphoma (5 observed vs. 
2 . 3 expected) , despite the predominance of the 
tumor in certain other immundeficiency states. 
Several cancer sites (oral, bladder and kid- 
ney) occurred excessively, but reasons for the 
observations were obscure. For example, His- 
panics showed higher rates of cancers of the 
liver and gallbladder. In sum, this follow-up 
study did not reveal a substantially increased 
cancer risk among patients with Hansen's dis- 
ease. There were certain other cancer sites 
(oral, bladder, and kidney) with elevated 



120 



risks, although these were probably related to 
various confounding factors in Hansen disease 
patients. 29 References. 



87. Author: Bryant, C. A. (1982). 

Title: The impact of kin, friend and neighbor net- 
works on infant feeding practices. Cuban, 
Puerto Ricans and Anglo families in Florida. 

Source: Social Science and Medicine , 16(20) , 1757- 
1765. 

Abstract: The study examines the impact of social net- 
works as a tool to determine the effect of 
kin, friend and neighbor networks on infant 
practices. The study population consisted of 
Cuban, Puerto Rican and Anglo families in Dade 
County, Florida. Inter-ethnic differences in 
network members were noted in connection with 
giving assistance and advice on infant care. 
These influences on specific feeding practices 
were discussed. The decision to breastfeed, 
bottle-feed, use of sucrose supplements and 
when to add solid foods to the baby's diet 
were significantly affected by the social 
network. Findings were that members of the 
network by offering advice did contribute to a 
successful lactation experience. However, the 
application of Fisher's exact test to a small 
subsample did not show a significant correla- 
tion between presence or absence of network 
support and the outcome of lactation. 
(Author's abstract modified). 



88. Author: Caetano, R. (1983). 

Title: Drinking patterns and alcohol problems among 
Hispanics in the U.S.: A review. 

Source: Drug and Alcohol Dependence , 12 , 37-59. 

Abstract: A review of the epidemiological literature 
available as of 1981, regarding Hispanic 
drinking. Data was derived from studies uti- 
lizing indirect measures, such as participa- 
tion in treatment programs, arrest records and 
mortality patterns. These investigations have 
inherent biases and do not seem very useful. 
Survey research promises a wider scope. As of 
the date of this article there has been a 
paucity of research targeted to the Hispanic 
population. Rather, Hispanics that happened 
to be included in larger samples have been the 
cases utilized for analyses. Unfortunately 
this has resulted in fairly small sample 
sizes. Given this previous type of research 
based on small, possibly biased samples, the 



121 



conclusions from different studies are often 
contradictory. A special caution is added 
that intra-Latino differences between Puerto 
Ricans, Mexicans and Cubans are likely to be 
great. 18 References. 



89 



Author: 
Title: 



Source: 
Abstract: 



Caetano, R. (1984) . 

Ethnicity and drinking in Northern California: 
A comparison among Whites, Blacks, and His- 
panics. 

Alcohol and Alcoholism, 19(1), 31-44. 
This research reports the drinking patterns 
and alcohol problems in three ethnic groups: 
Whites (N=2327) , Blacks (N=1206) and Hispanics 
(N=634) . Respondents were surveyed randomly 
from the general population of three counties 
surrounding San Francisco, California. One 
respondent, between the age of 19-59 years was 
randomly selected from each household for 
interviewing. Both Black and Hispanic females 
have higher rates of abstention than White 
females. Male drinking patterns are similar 
across ethnicities and prevalence of alcohol 
problems change dramatically according to age. 
Among White males, ages 2 0-3 years, drinking 
and associated problems decrease abruptly. 
Among Black males the trend is exactly the 
opposite of that for Whites, while among His- 
panic males there is also a decrease but not 
quite so large as that for Whites. The fre- 
quency of Hispanic heavy drinking and problems 
is always higher than for the other two 
groups. The types of problems reported by 
respondents do vary by ethnicity, but the 
sociodemographic correlates of both number of 
drinks consumed per month and number of alco- 
hol problems do differ among ethnic groups. 
Both Hispanics and Blacks have more liberal 
attitudes towards alcohol use than Whites. 
Whites, Blacks and Hispanic have different 
groups of people at risk for developing alco- 
hol problems and prevention should be planned 
accordingly. 3 References. 



90. Author: Caetano, R. (1984) . 

Title: Self-reported intoxication among Hispanics in 

Northern California. 
Source: Journal of Studies on Alcohol , 4_5(4) , 349- 

354. 
Abstract: Self-reported intoxication among Hispanics 

in Northern California was studied through 

three independent surveys of the general popu- 



122 



lation conducted between 1977 and 1980 in 
three counties of the San Francisco Bay Area. 
All of the surveys followed the same sampling 
plan and only probability techniques were 
employed. A total of 634 adult who identified 
themselves as Hispanics served as subjects. 
In the sample, 20% of the men and 5% of the 
women reported becoming intoxicated at least 
once a month, rates twice as high as in the 
general U.S. population. Intoxication was 
more frequent among the young and among heavi- 
er drinkers, and it was also a significant 
predictor of alcohol-related problems. It is 
suggested that intoxication be studied care- 
fully because of its association with alcohol 
related problems. 7 References. 



91. Author: Caracci, G. , Migone, P., & Dornbush, R. 

(1983) . 

Title: Phencyclidine in an East Harlem psychiatric 
population. 

Source: Journal of the National Medical Association , 
75(9) , 869-874. 

Abstract: The purpose of this study was to investigate 
the use of phencylidine (PCP) in a psychiatric 
population of an East Harlem hospital. The 
hospital provides services to a community that 
is 58% Hispanic, 21% Black, and 21% White. The 
Hospital is used by 48% Hispanics, 32% Blacks, 
and 20% Whites. The population served is a 
low socioeconomic one. Sixty-eight consecutive 
PCP users admitted to the hospital were inter- 
viewed through a 77 item questionnaire. The 
majority of the subjects were Black (86%) , 
single (72%) , and living with their parents 
(79%) . Based on the findings, it was con- 
cluded that either more Blacks use PCP or non- 
Black PCP users seek psychiatric help less 
frequently than Black users. In addition, the 
findings pointed to the many problems affect- 
ing the respondents and the risk for develop- 
ing psychiatric problems which exist in the 
population. 15 References. 

92. Author: Carpenter, J. L. , Obnibene, A. J., Gorby, E. 

W. , Neimes, R. E. , Koch, J. R. , & Perkins, W. 

L. (1983) . 
Title: Antituberculosis drug resistance in South 

Texas. 
Source: The American Review of Respiratory Diseases , 

128 , 1055-1058. 
Abstract: The purpose of this report was to study drug- 



123 



resistant patterns in South Texas. Age, sex, 
and ethnic group were not found to signifi- 
cantly affect the incidence of resistance. 
Four drugs were considered in this analysis. 
These included isoniazid, ethambutal, rifam- 
pin, and streptomycin. There was a 7.3% rate 
of resistance to isonized and/or ethambutal 
or rifampin for any individual organism. Based 
on the findings, it was concluded that the 
incidence of single and multiple anti- 
tuberculosis drug resistance in South Texas 
was found to be higher than previously docu- 
mented. 8 References. 



93. Author: Carrillo, R. A. & Marrujo, R. , (1984). 

Title: Acculturation and domestic violence in the 
Hispanic community . 

Source: Denver, Colorado: Servicios de la Raza, Inc. 

Abstract: The purpose of this paper was to report on the 
exploratory study of ten couples experiencing 
domestic violence. The study sought to estab- 
lish a relationship between acculturation, 
stress and domestic violence in a Hispanic 
community in Denver, Colorado. Acculturative 
stress was defined as "psychological distress 
or discomfort in daily events experienced by 
an individual or group attempting to adopt a 
new culture," (Padilla, et al, 1983). In 
treating ten battered couples, the investiga- 
tors found that differing levels of accultura- 
tion and acculturative stress produced marital 
conflicts in several areas. These included: 
sex role expectations, family obligations and 
relationships, and the permissible amount of 
the type of contact with persons/institutions 
associated with the host culture (U.S.). In 
particular, women who were more acculturated 
than their spouses tended to be more non- 
traditional in their attitudes toward women's 
roles and therefore clashed with males having 
more traditional sex role expectations. Based 
on the findings of this exploratory study, the 
authors recommended further research on the 
relationship of acculturative stress and do- 
mestic violence among Hispanic couples and 
well adjusted Hispanic couples should also be 
formulated. Finally, it was recommended that 
practitioners need to understand current 
models of acculturation to comprehend an indi- 
vidual's particular level of acculturative 
stress and its impact on the individual ' s 
psychological process. 5 References. 



124 



94. Author: 
Title: 
Source: 
Abstract: 



Castro, F. G. , Baezconde-Garbanati, L. , & 
Beltran, H. (1985) . 

Risk factors for coronary heart disease in 
Hispanic population: A review. 

Hispanic Journal of Behavioral Sciences , 7(2) , 
153-175. 

Epidemiological studies of coronary heart dis- 
sease (CHD) risk factors among Hispanics were 
examined. Hispanics as compared with Anglo 
Americans and Blacks appear to have somewhat 
lower mortality rates of CHD. This suggests 
that Hispanics may have lifestyle patterns 
which reduce CHD risk in the areas of: stress, 
diet, exercise, hypertension and smoking. 
However, independent studies report that their 
samples of Mexican American subjects, but not 
Puerto Rican subjects, had higher blood 
lipid levels, greater rates of being over- 
weight and participate in less aerobic exer- 
cises as compared with same sex and aged Anglo 
American cohorts. By contrast, adult Mexican 
Americans and Puerto Ricans tend to smoke less 
than do Anglo American cohorts, although some 
evidence suggests that Hipanic adolescents may 
smoke more than do their Anglo American peers. 
The CHD risk status of Hispanics is summarized 
and recommendations for future research and 
health promotion programs are made. Author's 
abstract. 72 References. 



95. Author: Chin, J., & Roberto, R. R. (1985, March-April). 

Title: Cysticercosis in California. 

Source: Border Epidemiological Bulletin , pp. 1-2. 

Abstract: A report on the problem of beef (Taenia 
saginata) and pork (Taenia solium) tapeworms. 
The two-stage life cycle of the parasites is 
charted. The conditions under which cysticer- 
cosis infestation by tapeworm can be acquired 
and passed on are described. Areas in which 
the affliction is endemic are listed. The 
behavior of the parasites, once ingested, is 
described, including sites of infestation and 
accompanying symptoms. Also discussed are 
methods of diagnosis and their relative effec- 
tiveness. From 1979 to 1983, 214 cases were 
reported in California. A CDC survey of 4 
major Los Angeles Hospitals serving large 
Hispanic populations found 458 cases between 
1973 and 1983. Possible factors leading to an 
increase in cysticercosis should be considered 
as a diagnosis when seeing patients from ende- 
mic areas who have neurological findings such 



125 



as unexplained seizures and headaches. 
References. 



96. Author: Collado, M. de L. , Kretshmer, R. R. , Becker, 

I., Guzman, A., Gallardo, L. , & Lepe, C. M. 
(1981). 

Title: Colonization of Mexican pregnant women with 
group B streptococcus. 

Source: The Journal of Infectious Diseases , 143.(1)/ 
134. 

Abstract: The purpose of this study was to document the 
incidence of Group B streptococcus (GBS) in 
200 lower, middle class Mexican American women 
in their last prenatal vist. Single rectal 
and endocervical swabs were done for identifi- 
cation of GBS. A 1.5% rate of endocervical 
colonization with GBS was found. This was 
statistically less than the rate found by 
previous research. The lower rate of GBS 
colonization in Mexican women in Los Angeles 
and Mexican women in Mexico City than in White 
and Black women in Los Angeles City may re- 
flect not only differences in genetic consti- 
tution but also differences in sexual practice 
and environmental factors such as hygiene and 
nutrition. Since the single most important 
factor in GBS infection in the neonate is the 
presence of microorganism in the maternal 
genital tract at birth, the low colonization 
rates among Mexican women may explain the low 
and sporadic incidence of sepsis due to GBS in 
neonates in Mexico. 1 Reference. 



97. Author: Coreil, J. (1984). 

Title: Ethnicity and cancer prevention in a tri- 
ethnic urban community. 

Source: Journal of the National Medical Association , 
76(10), 1013-1019. 

Abstract: This paper, published in 1984, presents the 
findings of ethnic awareness and naturally 
occurring behavioral changes needed to reduce 
cancer risk, with special attention to knowl- 
edge of recommended safeguards and dietary 
factors in cancer prevention. Most of the 
frequency differences of cancer among ethnic 
groups may be attributable to behavioral, 
social, and enviromental factors rather than 
biological or genetic characteristics. A 
household survey of 64 residents of Galveston, 
Texas, including 20 Blacks, 20 Mexican Ameri- 
can, and 24 White adults was conducted during 
the winter of 1982. A 45-item interviewer- 



126 



administered questionnaire was given to all 
subjects. Knowledge of smoking and dietary 
risk factors was substantial (78% and 36%, 
respectively) , but awareness of cancer safe- 
guards involving reduced sun exposure and 
mouth and proctological examinations was very 
low. One of five respondents had taken mea- 
sures to prevent cancer, and these persons 
tended to rate their own risk higher than 
respondents who made no life-style changes. 
Self -motivated behavior change focused pri- 
marily on avoidance of cancer»-promoting foods. 
Blacks had a lower awareness of cancer causes 
and prevention measures particularly regarding 
dietary factors and behavior modification than 
Whites and Mexican Americans. The findings 
reaffirm the need to consider ethnic back- 
ground when targeting health information to 
particular audiences. Television, magazines 
and radio were the major cancer information 
sources. 25 References. 



98. Author: Cuellar, J. B. (Ed.), (1983). 

Title: A la brava — frankly speaking about drug , alco- 
hol and substance abuse in the Chicano ex- 
perience . 

Source: San Diego, CA: San Diego State University. 

Abstract: This syllabus for a college course seeks to 
give the student a basic understanding of 
abuse in the Mexican American coummunity, 
especially the tecato subculture. Part one 
provides an overview of the drugs and sub- 
stances used and abused by Hispanics. Part 
two presents an analysis of the historical, 
political, and cultural perspectives involved 
in the development of drug abuse policies and 
treatment models which have directly affected 
the Hispanic addict. Part three examines the 
status of the Chicano addict in the tecato 
subculture and in correctional institutions 
from an insider's perspective. Part four is 
designed to increase the students awareness of 
basic characteristics of the tecato subculture 
as well as the contrasting values of counselor 
and addict, the different types of counselors, 
programs and treatment from the tecato per- 
spective and the most effective treatment 
approaches for the tecato. References. 

99. Author: Dawkins, R. L. , & Dawkins, M. P. (1983). 
Title: Alcohol use and delinquency among Black, 

White, and Hispanic adolescent offenders. 



127 



Source: Adolescence , 18(72), 799-809. 

Abstract: This study, published in winter 1983, examines 
the relationship between drinking and criminal 
behavior among adolescent male and female 
offenders in a northeastern state. Data were 
collected by means of questionnaires adminis- 
tered to 342 residents of a public juvenile 
facility. Analyses were performed separately 
for each racial subgroup including, Blacks, 
Whites and Hispanics. The results of the 
present study provide evidence which may help 
clarify the inconsistent findings of previous 
research on alcohol, delinquency and ethni- 
city. Based on simple correlations, the re- 
sults show that among each subgroup, drinking 
is strongly associated with minor (victimless) 
juvenile offenses. However, the correlation 
between drinking and serious offenses is 
strong only for Blacks and Whites, but not for 
Hispanics, which suggests that other socio- 
cultural experiences must be considered when 
attempting to assess the likelihood that will 
lead to serious criminal involvement among 
this group. Multiple regression analysis fur- 
ther reveals that relative to other background 
and behavioral factors, drinking is the 
strongest single predictor of criminal of- 
fenses among Blacks, with less importance for 
Whites and little importance for Hispanics. 
Implications for prevention are discussed. 24 
References. 



100. Author: Delano, B. G. , Lundin, A. P., & Friedman, E. 

A. (1982). 

Title: Successful home hemodialysis in purportedly 
unacceptable patients. 

Source: Nephron , 31 , 191-193. 

Abstract: Presentation of four cases of successful home 
hemodialysis experience by patients that could 
easily have been excluded from consideration 
for this type of therapy because of age, mari- 
tal status, intelligence, economic status and 
language proficiency. One of the cases in- 
cluded a 27-year-old Hispanic father of unspe- 
cified nationality living in downstate new 
York. 11 References. 



101. Author: Delgado, M. (1980). 

Title: Consultation to a Puerto Rican drug abuse 

program. 
Source: American Journal of Drug and Alcohol Abuse , 
7(1), 63-72. 



128 



Abstract: A case study of one consultant's experience 
working with a drug abuse program serving a 
Puerto Rican community in Massachusetts. The 
various steps taken to win staff confidence 
and cooperation are detailed, along with the 
substantive program suggestions. 35 Referen- 
ces. 



102. Author: Desmond, D. P., & Maddux, J. F. (1984). 

Title: Mexican American heroin addicts. 

Source: American Journal of Drug and Alcohol Abuse , 
10(3), 317-346. 

Abstract: Mexican Americans are the second largest 
ethnic minority group amongst visible opioid 
addict population in the United States. This 
study looks at previous research on historical 
background and indicates that socioeconomic 
problems: poverty, under education, poor com- 
mand of English, limited vocational skills and 
discrimination may be more important than 
cultural change. The difference between Mexi- 
can Americans and other Hispanic groups is 
discussed. Comment is made of the lack of 
research into the above areas prior to 1970. 
Clinical and research literature is reviewed, 
as well as presenting new data from studies in 
San Antonio. Prior research on heroin addic- 
tion, clinical and psychological studies is 
described and results compared. Findings are 
summarized and the authors state that, in 
their opinion, the drug dependence itself, and 
the physical, mental, and social changes which 
go with it, represent common features among 
heroin users which outweigh the ethnic differ- 
ences. 90 References. 



103. Author: Desmond, D. P., & Maddux, J. F. (1981). 

Title: Religious programs and careers of chronic 
heroin users. 

Source: American Journal of Drug and Alcohol Abuse , 
8(1), 71-83. 

Abstract: The purpose of this paper is to review the 
literature and report on the religious program 
participation of 248 San Antonio addicts, 87% 
of whom are Mexican American and have been 
followed from 1966 through 1980. All subjects 
were males residing in San Antonio who were 
treated for opioid dependence at the former 
U.S. Public Health Service Hospital in Fort 
Worth, Texas, between 1964 and 1967. For 95%, 
heroin was the principal drug used. During a 
twelve year period, 11% of the 248 entered 



129 



religious programs. While only 33 admissions 
occurred, the percent followed by a year or 
more of abstinence (44%) exceeded that of 
conventional treatment or correctional inter- 
ventions. It was concluded that the ability 
of religious programs to attract large numbers 
of clients is limited. However, major changes 
in attitudes and lifestyle occur among some 
participants. Successful participation is 
related possibly to a special motivational 
state at admission. The authors contended 
that religious programs may be viewed as 
sociotherapy and similiar to traditional 
therapeutic communities and other self-help 
programs. Factors thought to lead to success 
of religious programs among Mexican Americans 
may be: their unique religious orientations, 
their tradition of non-medical healing ri- 
tuals, such as curanderismo and their positive 
expectation of religious programs. 50 Refer- 
ences. 



104. Author: 
Title: 
Source: 

Abstract: 



G. , Chavez, M. N. , 



Gauthier, C. L. , 
migrant 



Dewey , K . 

Jones, L. B. , & Ramirez, R. E. (1983). 
Anthropometry of Mexican American 
children in Northern California. 
The American Journal of Clinical Nutrition , 37 
(May) , 828-833. 

The objective of this study was to evaluate 
the growth of a sample of migrant children in 
the Sacramento Valley of California, and to 
compare results to those found in studies in 
the previous decade. Anthropometric data were 
obtained from 2 09 Mexican American migrant 
children, 0-7 years of age. Physical examina- 
tions were completed on the preschool children 
by trained medical personnel. Hematocrit mea- 
surements for 170 children revealed that only 
13 children (7.6%) had hematocrits below ac- 
ceptable levels. Growth standards from the 
National Center for Health Statistics (NCHS) 
were used to determine the weight-for-height, 
height-for age, and weight-for-age growth 
percentiles of each child at each exam. Only 
15% of the children were at or below the 10th 
percentile of height-for-age, only 7% were 
above the 95th percentile of weight-for- 
height, and the weight-for-age distribution 
was very close to the NCHS standard, in con- 
trast to results obtained by earlier nutrition 
survey studies of Mexican American children. 
The mean percentile of weight-for-height in- 
creased significantly with age, while height- 



130 



for-age decreased. Growth rates for weight 
and height accelerated during their summer 
residence in the U.S., indicating that the 
adequate growth status of these children may 
be related to improved conditons for growth 
while in the U.S. 12 References. 



105. Author: Deyo, R. A. (1984) . 

Title: Pitfalls in measuring the health status of 
Mexican Americans: Comparative validity of the 
English and Spanish Sickness Impact Profile. 

Source: American Journal of Public Health , 74 (6) , 569- 
573. 

Abstract: A sample of 120 patients utilizing a walk-in 
clinic in San Antonio, Texas, was chosen to 
assess the internal consistency of English and 
Spanish versions of the same instrument. The 
Sickness Impact Profile (SIP) was translated, 
and applied in a clinical study of low back 
pain. Respondents were divided into three 
groups: Group I, Non-Hispanic (N-2 3) ; Group 
II, Mexican Americans who used the English 
version (N-54) ; Group III, Mexican Americans 
who used the Spanish version (N-43) . The 
internal consistency of responses of all three 
groups was excellent. However, when the con- 
struct validity was tested by correlating the 
SIP scores with clinically observed measures 
of disease severity, differences emerged. 
Group I responses appeared to be highly valid, 
while Group III were not. Group II responses 
were intermediate. Although both Groups II 
and III were Mexican American, there is reason 
to believe that those who speak only Spanish 
are different. They are generally less well 
educated, less fluent in English, and general- 
ly appear to be less "acculturated" than Group 
II respondents. The study concludes that 
Hispanics are very heterogeneous. 19 Refer- 
ences. 



106. Author: Dicker, L. , & Dicker, M. (1982). 

Title: Occupational health hazards faced by Hispanic 
workers: An exploratory discussion. 

Source: Journal of Latin Community Health , 1 (1) , 
101-107. 

Abstract: A study addressing occupationally related 
health problems of Hispanic Americans. Using 
1980 statistics from the Bureau of the Census 
and the Department of Labor, the placement of 
Hispanics across the United States and in the 
occupational and industrial order is des- 



131 



cribed. Based on 198 Department of Labor 
statistics, the relative health hazards in 
each industry are listed. The major findings 
are that 47% of all Hispanics work in the five 
highest categories in terms of overall health 
risk and that 64% of Hispanics are blue-collar 
workers. This report focuses on broad indus- 
trial and occupational categories and related 
risks associated with them, thereby laying the 
groundwork for further study of particular 
problems. 5 References. 



107. Author: Diehl, A. K. , Stern, M. P., Ostrowers, V. S., 

& Friedman, P. C. (1980) . 

Title: Prevalence of clinical gallbladder disease in 
Mexican American, Anglo and Black women. 

Source: Southern Medical Journal , 73_(4), 438-441, 443. 

Abstract: A study to determine the status of gallbladder 
disease in ambulatory Mexican American women, 
in comparison to that of Black and White wo- 
men. The records of 1,018 women patients of 
the Family Health Center of the University of 
Texas Health Science Center were retro- 
spectively reviewed. They were all of low 
socioeconomic background, aged 15 to 59. Of 
these, 551 were Mexican American, 111 Anglo, 
and 356 Black. A variety of factors relating 
to medical history were noted. The presence 
of gallbladder disease was determined by a 
hospital record of surgery for gallstones, a 
history of cholecystectomy, or a record of 
abnormal results of an oral cholecystogram. 
These categories were tested for statistical 
significance using the chi squared test and 
differences in continuously distributed vari- 
ables were evaluated, using the student's t 
test. The five variables tested in the analy- 
sis of variance model were: presence or ab- 
sence of gallbladder disease, age decade, 
presence or absence of diabetes, ethnic group, 
and degree of adiposity. Mexican American 
women were found to have a prevalence of gall- 
bladder disease three times that of Black 
women, with Anglo rates falling in between. 
Gallbaldder disease was also positively asso- 
ciated with increasing age and diabetes. An 
association with obesity was shown but could 
not be shown to be independent of other risk 
factors. Multivariate analysis showed ethnic/ 
racial background to be an important contrib- 
utor to gallstone prevalence even after age, 
adiposity, and diabetes had been considered. 
The researchers suggest that Mexican American 



132 



heritage and diabetes mellitus are risk fac- 
tors for gallbladder disease which should be 
taken into account by the examining physician 
when making a diagnosis. References. 



108 



Author: 

Title: 



Source: 



Abstract; 



Dominquez, S. (1980, Fall). 

Tuberculosis in the Chicano communities of Los 
Angeles : is there an epidemic ? What is being 
done about it ? 

(Available from UCLA Chicano Studies Research 
Library, 3121 Campbell Hall, UCLA, Los 
Angeles, California 90024) . 

This document attempts to provide an answer to 
the question of a possible tuberculosis epide- 
mic in the Latino community. Area data indi- 
cate that while the number of cases is rising, 
they are occurring in the Black and Asian 
areas of Los Angeles: cases are dwindling in 
the Latino areas. Anecdotal data from inter- 
views with provider are furnished. 12 Referen- 
ces. 



109. Author: Domino, G. (1981). 

Title: Attitudes toward suicide among Mexican Ameri- 
can and Anglo youth. 

Source: Hispanic Journal of Behavioral Sciences , 3_(4) , 
385-395. 

Abstract: Suicide rates for Mexican Americans are lower 
than for Anglos, but are accelerating quite 
rapidly. This study decribes the attitudes 
Mexican Americans have towards suicide. A 
suicide opinion questionnaire (SOQ) was admi- 
nistered to 76 Mexican Americans and 76 Anglos 
from three Arizona communities, equated on 
several demographic dimensions. An item 
analysis yielded statistically significant 
differences on 35 of the 100 SOQ items. Twice 
as many Mexican Americans believe that the 
higher incidence of suicide is due to the 
lesser influence of religion. The present 
results fully support earlier observations 
indicating that while the incidence of ritual- 
istic expression of Catholicism among Mexican 
Americans may be low, religious beliefs do 
play a major role in their daily lives. On 
the psychopathological aspects of suicide, 
Mexican Americans were more likely to label 
suicidal persons as mentally ill but less 
likely to consider them under stress. Anglos 
tend to accept suicide more as a possibility 
to end incurable illness. Also a greater 
proportion of Mexican Americans believe that 



133 



those who threaten to commit suicide rarely do 
so and mention that it's more of a "cry for 
help." Finally, the results show that suicide 
has a greater emotional impact upon Mexican 
Americans. The implications of these finding 
are briefly discussed. 19 References. 



110. Author: 
Title: 
Source: 



Abstract: 



the 



77- 



Fortmann, S. P., Williams, P.T. , Hulley, S.B., 
Maccoby, N. , & Farquher, J. W. (1982). 
Does dietary health education reach only 
privileged? 

The Stanford Three Community Study , 6j6(l) , 
82. (Stanford Heart Disease Prevention Pro- 
gram and the Department of Medicine and Commu- 
nication, Stanford University School of Medi- 
cine) . 

The Stanford Three Community Study is a quasi- 
experimental field study to determine if a 
community-directed health education program 
could reduce the risk of cardiovascular dis- 
ease among a cross-cultural adult population 
ages 35-59, and to determine the responses of 
different social groups to the educational 
efforts. The relationship of selected social 
factors to diet, weight and plasma cholesterol 
was studied in one control and two treatment 
towns before and after a 3-year, bilingual, 
mass-media health education program. Spanish- 
speaking persons reported higher dietary cho- 
lesterol and saturated fat than English- 
speaking participants at baseline, and this 
remained true after adjusting for the con- 
founding influence of socioeconomic status 
(SES) . Obesity was also more prevalent in 
Spanish-language and low-SES groups, but 
plasma cholesterol was not related to these 
sociodemographic factors. Over the 3 years of 
the education program, all groups reported 20- 
40% decreases in dietary cholesterol and 
saturated fat. These decreases were as large 
in low-SES groups as in high-SES groups; 
Spanish-speaking participants reported signi- 
ficantly greater decreases in dietary satu- 
rated fat (p=0.02). Weight change was not 
related to either SES or language group, but 
change in plasma cholesterol was marginally 
more favorable in Spanish-speaking subjects 
(p=0.06). 31 References. 



111. Author: Gibson, G. , & Torres, A. 
Title: Child abuse and neglect: 
community. 



M. (Eds.). (1981). 
The Mexican American 



134 



Source: Proceedings of the First Annual Conference on 
Child Abuse and Neglect in the Mexican 
American Community . Texas Migrant Council, 
Laredo, Texas. 

Abstract: The First Annual Conference on Child Abuse and 
Neglect in the Mexican American Community, 
sponsored by the Texas Migrant Council and the 
National Resource Center on Child Abuse and 
Neglect for Mexican Americans, met in Laredo, 
Texas. The conference focused attention on 
the severe problems of abuse and neglect among 
Mexican American children in general and among 
those whose families are migrants in particu- 
lar. Ten papers were presented in two catego- 
ries: 1) Child abuse and neglect and the 
Mexican American community: issues and ap- 
proaches to problems; 2) Child abuse and neg- 
lect research and the Mexican American. Topics 
Of discussion included lack of staff members 
who speak Spanish or understand the culture of 
Mexican American families in child protective 



agencies, 



and the fact that lack of all adult 



members of the family must work leads to 
children being left in care of their siblings. 
The importance of recognizing the differences 
between Mexicans, Mexican Americans, and other 
Latinos was stressed. Discussed was the lack 
of accurate demographic information as well as 
a need for in-service training to minimize 
problems of insensitivity . Consensus was 
that problems of child abuse and neglect among 
migrant families are serious, but there were 
ideological variations as what was considered 
the "best" solution. 18 References. 



112. 



Author : 
Title: 



Source: 



Abstract; 



Gilbert, M. J. (In Press) . 

Intracultural variation in attitude and be- 
havior related to alcohol: Mexican Americans 
in California. 
In L. Bennett and 
can Experience 
Plenum Press, 



G. Aimes. (Eds.) 
with Alcohol. New 



The Ameri- 



York, 



NY: 

A paper based on ethnographic work in three 
heavily Mexican American areas: Los Angeles, 
Fresno and San Jose. Drinking in private 
(weddings, baptisms, birthdays) and public is 
studied qualitatively. Differences are noted 
between foreign and nativeborn drinking pat- 
terns. Foreign born tend to drink in singles 
sex situations, native born tend to drink in 
mixed sex situations. Class differences com- 
pound the nativity differences. Rising class 
females tend to drink more than lower class; 



05 



still, significant sex differences in drinking 
patterns exist. The effect of alcohol use on 
kinship and marriage interaction is examined. 
Alcohol consumption is seen as deviant only 
when it impairs social relations or perform- 
ance of role-related obligations. 24 Referen- 
ces. 



113. Author: Glick, R. (1983). 

Title: Dealing , demoralization and addiction: Heroin 
in the Chicago Puerto Rican community. 

Source: Journal of Psychoactive Drugs , 15(4), 281-292. 

Abstract: This article reports findings from ethno- 
graphic research on heroin addiction. The 
subjects interviewed were Puerto Rican drug 
dependents and/or ex-addicts from the Chicago 
area. The results emphasize the relationship 
among social barriers, family demoralization 
and addiction to escape life's problems. 
These findings support a sociological inter- 
pretation which suggests that among the lower- 
class, addiction is used to escape from the 
sense of failure brought on by lack of oppor- 
tunity. The analysis of the results empha- 
sizes the influence of social inequality that 
has impacted heavily on many families, thus 
frustrating achievement of life goals, bring- 
ing discouragement and addiction. Although 
addiction for many of the Chicago Puerto Rican 
respondents was motivated by the need to 
escape life problems, this does not mean that 
respondents were passive. In fact, out of 
necessity respondents pursued an active life- 
style including affiliation with gangs. Also 
discussed are the dilemmas confronting female 
Puerto Rican addicts. The problem of heroin 
addiction does not rest so much with the ad- 
dicts, but rather in the lack of opportunity. 
Judging from research among Chicago's Puerto 
Ricans, these reports may indicate both the 
extent of drug dealing and the extent of de- 
moralization these communities are experi- 
encing. 19 References. 

114. Author: Gonzalez, D. H. , & Page, J. B. (1981). 
Title: Cuban women, sex role conflicts and the use of 

prescription drugs. 

Source: Journal of Psychoactive Drugs , 13_(1) , 47-51. 

Abstract: This is an ethnographic study of 100 Cuban 
immigrant women residing in Dade County. The 
purpose of the study was to analyze prescrip- 
tion drug use among Cuban immigrant women. It 



136 



was hypothesized that the use of prescription 
drugs was an adaptive strategy to relieve the 
stress originating from the discrepancies 
between Cuba and the U.S. in the respondents' 
socioeconomic status, sex roles, cultural 
background and lifestyle in general. A brief 
screening interview was given that requested 
information on drug use patterns of all re- 
spondents. Results indicated that almost 
three-fourths of these women had used pills 
(usually minor tranquilizers) . Of these, 30% 
use them daily or more frequently. Also, half 
of the interviewed women used sleep aids 
(sedatives and tranquilizers) on a regular 
basis. The relationship between presence or 
absence of sources of stress and patterns of 
intensive drug use was not shown to be signi- 
ficant. However, subjects did state that exile 
uncertaintly (i.e., anxiety about fate of 
relatives, income, employment, repatriation) 
and acculturation problems were the two most 
important reasons for their drug use. 16 
References. 



115. Author: Gordon, A. J. (1981). 

Title: The cultural context of drinking and indigen- 
enous therapy for alcohol problems in three 
migrant Hispanic cultures. 

Source: Journal of Studies on Alcohol , 9 (Supplement) , 
217-240. 

Abstract: An ethnographic study of drinking and treat- 
ment patterns among three Latino groups in a 
small "New England" town: Dominicans, Guate- 
malans and Puerto Ricans. No statistical 
analysis is provided. Dominicans were up- 
wardly striving immigrants with families, who 
drink little and in moderation. The Guatema- 
lans were largely males without families, who 
evidenced much drinking, rapidly and in great 
quantity. They tended to use an Alcoholics 
Anonymous group composed almost entirely of 
Guatemalans. Puerto Ricans were poly drug 
users, and seemed not to be striving for up- 
ward mobility. They used pentecostal, evan- 
gelical churches for treatment via being "born 
again." 13 References. 

116. Author: Guerra-Ellis, I. (1984, September). 
Title: Hansen' s disease in Hispanic patients . 
Source: Paper presented at the meeting of the National 

Association of Hispanic Nurses, Los Angeles, 
California. 



137 



Abstract: The states in which Hansen's disease is ende- 
mic have large Hispanic populations. The 
highest prevalence is found in Texas. Approxi- 
mately 45% of the residents in the National 
Hansen's Disease Center are Hispanic, suggest- 
ing that this disease may be somewhat more 
prevalent in this group than in others. This 
paper presents a protocol of etiology, symp- 
toms and treatment, which are applicable to 
all Hansen's disease patients. Some psycho- 
social aspects are noted which are applicable 
to all populations. This is not a survey or 
clinical study, but rather a protocol for 
sensitization of professionals. References. 



117. Author: Haider, S. Q., & Wheeler, M. (1980). 

Title: Dietary intake of low socioeconomic Black and 
Hispanic teenage girls. 

Source: Journal of the American Dietetic Association , 
77(6), 677-681. 

Abstract: The present study was undertaken to assess and 
compare the 1974 Recommended Dietary Allowan- 
ces (RDAs) with the nutrient intake of teenage 
girls in Black and Hispanic families residing 
in the Bedford-Stuyvesant section of Brooklyn, 
New York. Comparison was also made with the 
intake of their mothers. The site has a popu- 
lation of 75% Blacks and 23% Hispanic. Syste- 
matic random selection was used to select 75 
Black and 75 Hispanic teenage girl-mother 
pairs. The instruments of data collection 
were: (a) a 24-hour dietary recall and a 2-day 
record, (b) a foodbuying and preparation ques- 
tionnaire, and (c) anthropometric measure- 
ments. Private interviews were conducted by 
the authors and five specially trained advan- 
ced nutrition college students. Results were 
compared to the 1974 RDAs. It was found that 
the intake of all nutrients was either below 
or close to the RNA levels for all ages, the 
exception being that protein and ascorbic acid 
intake was considerably higher. Vitamin A 
intake of both Blacks and Hispanics were with- 
in or higher than recommended levels. The 
findings on caloric intake suggest a relative- 
ly high consumption of bacon and fatty meats 
and low intake of fruits and vegetables. 
There was no significant differences between 
the pooled mean nutrient intakes of Black and 
Hispanic girls. Anthropometric data indicated 
a prevalence of overweight, particularly in 
the Black population. Comparison of mothers 
and daughters showed similar intakes. Poverty 



138 



was a sore significant factor than race for 
the data of this study. Conclusions were that 
any effective nutritional program roust include 
proper selection, buying and meal preparation 
of food for the entire family as well as an 
emphasis on regular eating habits. 27 Refer- 
ences. 



118. Author: Hasir, H. E. (1982). 

Title: The relationship between vitamin B-6 levels in 
the diet and breast milk of ten Mexican Ameri- 
can women . 

Source: Ann Arbor, MI: University Microfilms Inter- 
national, No. 1319547. 

Abstract: The purpose of this study was to analyze the 
diets of ten lactating low socioeconomic women 
to determine if vitamin B-6 ratios met the 
Recommended Dietary Allowances of 0.02mg vita- 
min B-6: protein ratio, and to determine if 
dietary vitamin B-6 levels were correlated 
with breast milk levels in these women. The 
Saccharomyces carlsbergensis microbiological 
assay was utilized to measure vitamin B-6 in 
the milk samples. It was found that vitamin 
B-6 levels were within the suggested range 
according to the National Research Council. A 
statistically significant, positive correla- 
tion was found between dietary vitamin B-6 and 
breast milk among 8 subjects. It was con- 
cluded that despite marginal maternal intakes 
of vitamin B-6, the breast milk levels of low 
socioeconomic Mexican American women seemed to 
be adequate to fulfill the needs of their 
infants, based on the National Research Coun- 
cil. 26 Reference. 



119 



Author : 
Title: 



Source: 

Abstract: 



Hazuda, H. P., & Haffner, S. M. (1984). 
Acculturation as a protective factor against 
diabetes in Mexican Americans: The San 
Antonio Heart Study. 
Diabetes , 33^(5), 30A. (No. 117). 
Non-insulin dependent diabetes mellitus 
(NIDDM) is a roajor health problem of Mexican 
Americans, the largest Hispanic subgroup in 
the U.S. Authors recently reported that rela- 
tive to Anglo Americans, Mexican Americans 
have a two to threefold excess of diabetes, 
even after adjusting for differences in obesi- 
ty. This study examined whether higher levels 
of acculturation (adoption of Anglo American 
behaviors, attitudes and values) are associa- 
ted with lower NIDDM prevalence among Mexican 



139 



Americans. Subjects were a random sample of 
Mexicans (532 men, 707 women), ages 25-64, 
selected from three socioeconomically distinct 
neighborhoods. Levels of acculturation in 
adulthood were measured using scales which 
evidenced excellent construct validity and 
internal consistency. NIDDM was diagnosed 
using the NDDG criteria. Tests for linear 
trend across levels of acculturation were run 
separately for men and women, using multiple 
logistic regression with adjustments for age 
and SES. Increased levels of acculturation 
were consistently associated with a reduction 
of NIDDM prevalence for both men and women. 
After an additional adjustment for obesity, 
results suggested that the effect of acultura- 
tion on NIDDM is largely mediated through 
obesity for women but is largely independent 
of obesity for men. (Journal abstract modi- 
fied.) 



120. Author: Hazuda, H. P. (1984), November 30). 

Title: Differences in socioeconomic status and accul- 
turation among Mexican Americans and risk of 
cardiovascular disease . 

Source: Paper presented to the Task Force on Black 
and Minority Health, Bethesda, MD. 

Abstract: The purpose of this paper is to review the 
available literature to assess the extent to 
which increasing differences in socioeconomic 
status and acculturation among Mexican Ameri- 
cans are associated with differences in car- 
diovascular risk factors and to make public 
health recommendations based on the findings. 
The author reviews education, occupation, and 
income among Mexican Americans. Cardiovas- 
cular disease as a cause of death among Mexi- 
can Americans is discussed, focusing on stu- 
dies done in this area. Twenty-one research 
reports between 1966 and 1984 concerning so- 
cioeconomic status and acculturation among 
Mexican Americans are next discussed. The 
evidence contained in these reports deals with 
six risk factors: lipids and lipoproteins, 
blood pressure and hypertension, cigarette 
smoking, exercise, obesity, and diabetes. The 
studies indicate that within the Mexican 
American population, those in the lowest 
socioeconomic group and those who are the 
least acculturated have a significantly worse 
profile of cardiovascular risks than those in 
higher socioeconomic groups and those who 
are more acculturated. Obesity and noninsulin 



140 



dependent diabetes mellitus rank as major 
health problems in Mexican Americans of both 
sexes. For Mexican American males, hyper- 
tension and cigarette smoking rank as signifi- 
cant health problems as well. Greater hyper- 
triglyceridemia and lower levels of high den- 
sity lipoprotein cholesterol in both sexes 
exist along with greater hypercholesterolemia 
and higher levels of low density lipoprotein. 
Cholesterol in males relative to non-Hispanic 
Whites should also be recognized as a public 
health concern. Public Health recommendations 
included: research on genetic and life-style 
factors related to insulin dependent diabetes 
mellitus in Mexican Americans, public health 
education concerning hypertension and smoking 
among Mexican American males, the monitoring 
of lipids and lipoproteins in Mexican Ameri- 
cans, and focusing on the lower levels of 
socioeconomic status in order to lower the 
profile of coronary risk among Mexican Ameri- 
can. 43 References. 



121, 



Author : 



Title: 

Source: 
Abstract: 



Heisel, M. A., Siegel, S. E., Falk, R. E., 
Siegel, M. M. , Carmel, R. , Lechago, J., Skaff, 
G. , Roessel, T. , Nielsen,P. G. , & Cummings, P. 
(1984) . 

Congenital pernicious anemia: Report of seven 
patients, with studies of the extended family. 
The Journal Pediatrics , 105 (4) , 565-568. 
The purpose of this paper is to describe seven 
cases of congenital pernicious anemia in an 
extended family which included seven children 
ranging from 1 1/2 to 12 years. All of the 
affected children had megaloblastic anemia 
accompanied by low serum B12 and normal serum 
folate levels. Normal gastric acidity along 
with normal serum folate levels was revealed 
by gastric fluid analysis. Serum antibodies 
to intrinsic factor or parietal cells were 
also absent. Schilling tests were done on six 
of the patients and produced abnormal results. 
A gastric biopsy was done on 3 of the patients 
with two having normal histologic finding and 
one with mild atrophy. All patients responded 
to parenteral administration of vitamins B12. 
One hundred and seventy extended family mem- 
bers were screened for the defect with com- 
plete blood counts and serum B12 levels. Doing 
such screening detected two of the children. 
No other abnormalities that could be attri- 
buted to pernicious anemia were detected. 
Long term studies in these patients, as well 



141 



as surveillance of the other family members 
will be necessary to rule out the possibility 
of additonal cases developing with time. De- 
tection of the carrier will probably require 
careful quantification of the levels of in- 
trinsic factor secreted into the gastric 
juice. Based on the family pedigree, autoso- 
mal recessive inheritance is likely. The vari- 
ability of age presentation in this family is 
noteworthy and suggests that expression may be 
modified by still undefined factors. 33 Ref- 
erences. 



122. Author: Hoft, R. H. , Bunker, J. P., Goodman, R. I., & 

Gregory, P. B. (1981) 

Title: Halothane hepatitis in three pairs of closely 
related women. 

Source: The New England Journal of Medicine , 304 (17) , 
1023-1024. 

Abstract: The purpose of this study was to investigate 
if a genetic component may be involved in 
halothane hepatotoxicity. In this study, 
three pairs of closely related women developed 
hepatitis following anesthesia with halothane. 
Two of the patients were mother and daughter, 
two were sisters, and two were first cousins. 
All reported either Mexican Indian or Mexican 
Spanish origin. No ancestors were shared by 
the three pairs. All lived in California. The 
authors contended that based on their observa- 
tions of post-halothane hepatitis in these 
closely related women with a common origin, 
familial susceptibility to halothane-induced 
hepatotoxicity may exist since the probability 
that this could occur by chance alone is very 
small. The authors postulated that if a fami- 
liar basis for some cases of halothane hepati- 
tis exists, it may have not been reported 
because most surveys of this conditon have 
been performed in the United States and Europe 
where persons of Hispanic origin are in the 
minority. 14 References. 



123. Author: Holland, T. R. , Levin, M. , & Beckett, G. E. 

(1983) . 

Title: Ethnicity, criminality, and the Buss-Durkee 
Hostility inventory. 

Source: Journal of Personality Assessment , 47(4) 375- 
378. 

Abstract: A small-scale survey to apply the Buss-Durkee 
Hostility Inventory (BDHI) scale to the pre- 
diction of violent and non-violent crime in a 



142 



multi-ethnic sample. One hundred fifty-one 
offenders in a California correctional 
facility were utilized. There were 40 Whites, 
53 Mexican Americans, and 48 Blacks. The BDHI 
tested for two hostility scales (Resentment 
and Suspicion) and five aggression scales 
(Assault, Indirect Aggressiveness, Irrita- 
bility, Negativism, and Verbal Aggression. 
The rankings on these scales were then com- 
pared with violent or non-violent nature of 
the most recent offenses. There was no sta- 
tistically significant association between the 
scale scores and the violence of the most 
recent offense. When the ethnic groups are 
compared, Whites have higher Indirect Aggres- 
sion, Irritability and Verbal Aggression 
scores than Blacks, and lower Suspicion. Mexi- 
can-Americans occupied a place between the two 
other groups. The study concludes that vio- 
lent criminal conduct is more likely a product 
of situational, sociocultural, and physio- 
logical variables, rather than of the 
psychological characteristics of offenders. 14 
References. 



12 4. Author: 



Title: 

Source: 

Abstract; 



Honig, G. R. , Seeler, R. A., Shamsuddin, M. , 
Vida, L. N., Mompoint, M. , & Valcourt, E. 
(1983) . 

Hemoglobin Korle Bu in a Mexican family. 
Hemoglobin , 7(2), 185-189. 

The purpose of this report is to discuss the 
identification of the Hb Korle Bu in a Mexi- 
ican Indian family from Durango. Second, this 
paper describes a method for confirming the 
presence of this variant. The index case 
involved a 23-month-old Mexican child in Cook 
County Hospital Chicago, Illinois, who demon- 
strated a "AS" pattern with a negative sick- 
ling test based on hemoglobin electro- 
phoresis. Studies of this distribution of 
abnormal hemoglobins in Mexico have demon- 
strated a high incidence of Hb S, especially 
in coastal areas formerly active in African 
slave trade. Surveys among various Indian 
populations of Mexico have demonstrated an 
absence of abnormal hemoglobins. The family 
described in this report was from an isolated 
rural area of West Central Mexico and of 
Indian heritage. The possibility that this 
hemoglobin in this family may have resulted 
from an independent mutation was considered. 
15 References. 



143 



125. Author: 
Title: 



Source: 
Abstract: 



Horton, P. A. (1981) . 

Utilization of alcoholism services by Mexican 
Americans: A case study in social networks 
and ethnic marginal ity . 

Ann Arbor, MI: University Microfilms Inter- 
national, No. 8215857. 

The goal of this doctoral dissertation was to 
document the process of a specialized health 
care delivery system as a case study in the 
dynamic of urban assimilation and/or margin- 
ality of Mexican Americans. This work at- 
tempts to delineate a unifying system model of 
social prevalence of alcohol problems among 
Mexican Americans as well as the failure of 
appropriate health care systems to respond 
adequately. The ethnographic study was con- 
ducted in Santa Barbara, California. Informa- 
tion about treatment and prevention programs 
was obtained while the author was on the staff 
of the National Council of Alcoholism. This 
provided him with access to a wealth of infor- 
mation about 1) agencies involved in treatment 
and prevention of alcohol problems, 2) gov- 
erning bodies of treatment agencies and 3) 
related service groups for outreach and commu- 
nity interface. The findings suggest that 
underutilization of treatment facilities by 
Mexican Americans is not a matter of cultural 
fit, but of structural marginalization which 
works to exclude Mexican Americans from the 
flow and distribution of resources. The irony 
of this is that the processes of marginaliza- 
tion which play a fundamental role in genera- 
ting excessive alcohol use are replicated by 
the very urban subsystems controlling modern 
treatment resources for alcohol problems. Most 
resources immediately accessible to these 
troubled families are equipped with neither 
the knowledge or organizational resources to 
deal with alcohol dependence. Agencies pro- 
viding alcohol treatment are generally not ac- 
cessible and are not equipped to deal with the 
specific needs of the Mexican Americans and 
the urban environment (or the inability to 
interact) maintain a disequilibrium leading to 
increasing alcohol dependence, and the process 
of social marginalization is sustained vis-a- 
vis the treatment delivery system. 185 Ref- 
erences. 



126. Author: 



Howard, C. A., Samet, J. M. , Buechley, R. , W. , 
Schrag, S. D. , & Key, C. R. (1983). 



144 



Title: Survey research in New Mexico Hispanics: some 
methodological issues. 

Source: The American Journal of Epidemiology , 117 (1) , 
27-34. 

Abstract: In order to explain differing pattern of res- 
piratory disease epidemiology in Hispanic and 
Anglos, a prevalence survey was done in Albu- 
querque, New Mexico. Population for the sur- 
vey was randomly selected from the 1978 R. L. 
Polk & Co. Directory. Ethnicity of the study 
population was obtained by self-reporting by 
respondents, 1980 Census list of Spanish sur- 
names and a computer system known as Generally 
Useful Ethnic Search System (GUESS) . Compari- 
son of the methods of obtaining ethnicity 
indicated, when compared with self -reporting, 
that the census list was more specific (97%) 
and GUESS was more sensitive (90% sensitivi- 
ty) . Intermarriage reduced the accuracy in 
females. Emphasis of this paper was on the 
methodological issues raised during the con- 
duct of the study: respondent rates, potential 
language barriers and bias, and identification 
of Hispanic by surnames. Approaches to obtain 
adequate response rates were mail, telephone, 
and personal interviews. Highest response 
(78%) was from Anglo females: lowest from 
Hispanic males (60%) , with 22% refusing to be 
interviewed. Less Hispanics returned mailed 
questionnaires than responded to telephone 
interviews and as the respondents age in- 
creased, preference was for the Spanish lan- 
guage. (Author's abstract modified). 



127 



Author : 

Title: 

Source: 
Abstract; 



Hunt, I. F., Murphy, N. J., Cleaver, A. E. 



Faraji, B. , Swenseid, M. 



Coulson, A. H. , 



Clark, V. A., Browdy, B. L. , Cabalum, M. T., & 
Smith, Jr., J. C. (1984). 

Zinc supplementation during pregnancy: Effects 
on selected blood constituents and on progress 
and outcome of pregnancy in low-income women 
of Mexican descent. 

The American Journal of Clinical Nutrition , 40 
(September), 508-521. 

The effects of oral zinc supplementation on 
levels of various blood constituents and the 
outcome of pregnancy in 213 women of Mexican 
descent with low-incomes who attended a pre- 
natal clinic in Los Angeles was assessed in 
this double-blind experimental study published 
in September, 1984. The women were randomized 
into either a control (C) or a zinc- 
supplemented (Z) group and received similar 



145 



vitamin mineral supplements except that 20 mg 
zinc was added to the Z group's capsules. At 
the final interview, women (C+Z) with low 
serum Zn levels (53 ^ ug/dl) had higher 
(p<0.01) mean ribonuclease activity and lower 
(p<0.01) mean delta-aminoluvulinic aid dehy- 
dratase activity than women with acceptable 
serum zinc levels. The incidence of pregnancy- 
induced hypertension (PIH) was higher 
(p<0.003) in the C than in the Z group but PIH 
was not associated with low serum zinc levels 
at either the initial or final interview. 
Two factors, absence of zinc supplement and 
unmarried status, were found to be predictive 
of PIH. The expected increase in serum copper 
levels was greater (p<0.001) in women with PIH 
(C+Z) than in normotensives. Women with PIH, 
in contrast to normotensive women, reported 
diets that provided a lower energy value and 
less protein and carbohydrate at the final 
than at the initial interview. Except for PIH 
there was a higher incidence of abnormal out- 
comes of pregnancy in the non-compliers than 
in the compilers (C+Z) and not between control 
and zinc-supplemented groups. The incidence of 
spontaneous abortion, preterm delivery and 
low-birth weight infants was higher among 
noncompliers. 42 References. 



128. Author: Judson, F. N., Sbarbaro, J. A., Tapy, J. M. , & 

Cohn, D. L. (1983). 

Title: Tuberculosis screening: Evaluation of a food 
handler ' s program . 

Source: Chest , 8_3 (6) , 879-882. 

Abstract: All applicants for a food handler license in 
Denver, Colorado, were skin tested for tuber- 
culosis. Of the total 6,090 applicants, 1,209 
were classified as Hispanic (nationality un- 
know) . Hispanics had the highest rate of 
positive reaction (14.6%), Whites the lowest 
(4.7%) and Black intermediate (11.0%). A risk 
benefit analysis is performed, showing cost 
effectiveness of this type of screening pro- 
gram. 26 References. 



129. Author: 
Title: 
Source: 
Abstract: 



Kalter, D. C. , Goldberg, L. H. , & Rosen, T. 
(1984) . 

Darkly pigmented lesions in dark-skinned 
patients. 

The Journal of Dermatologic , Surgery and On- 
cology , 10(11), 867-881. 
This report begins with a case study of two 



146 



male Latin American adult patients with skin 
lesions suspected of being malignant melanoma 
(MM) . The case studies illustrate the prob- 
lems associated with determining the nature of 
darkly pigmented, suspicious lesions in dark- 
skinned patients. Furthermore, there is 
little information available to help the prac- 
titioner in the diagnosis of pigmented skin 
lesions in dark-skinned patients. One of the 
major problems is that the basal-cell epithe- 
liomas appear to be darkly pigmented in dark- 
skinned people, thus, leading to erroneous 
diagnosis and treatment as melanomas. The 
incidence of MM in Whites, Blacks, and His- 
panic in New Mexico and Texas are also discus- 
sed. The findings indicate that Blacks have 
an incidence of MM from 5-18 times less than 
Whites, while Hispanics have a higher inci- 
dence than Blacks, but 3.5 to 4.5 times less 
than Whites. 40 References. 



130. 



Author : 
Title: 



Source: 
Abstract: 



Kasim, S., & Bessman, A. (1984). 
Thyroid autoimmunity in Type II (non-insulin- 
dependent) diabetic patients of Caucasoid, 
Black and Mexican origin. 
Diabetologia , 27 59-61. 

Four hundred and forty-nine subjects with Type 
II (non- insulin-dependent) diabetes mellitus 
were selected from patients who regularly 
attended a diabetic outpatient clinic at a Los 
Angeles County facility for the medically 
indigent, to be screened for the presence of 
thyroid microsomal antibodies. These were 
matched with 270 control subjects for age, 
sex, and ethnicity. Of those selected, 134 
were Mexican as were 70 of the control 
subjects (method of identification was not 
specified) . Mexican female controls had a 
significantly higher frequency of thyroid 
microsomal antibodies when compared with Black 
female controls. Type II diabetic patients 
did not have a higher frequency when compared 
with their matched control counterparts. A 
subgroup of patients who required insulin for 
control of their blood glucose did not have a 
higher frequency of thyroid microsomal anti- 
bodies when compared with noninsulin-requiring 
diabetic patients. Autoimmunity against thy- 
roid gland is not more common in Type II 
patients when compared with matched control 
subjects. 11 References. 



147 



131. Author: Kayaalp, 0., Muller, C. , Forman, M. , & Kaplan, 

D. (1981, November) . 

Title: Health Status and Service Utilization of His- 
panic Patients with Arthritis . 

Source: Paper presented at the meeting of the American 
Public Health Association's 109th Annual 
Meeting, Los Angeles, California. 

Abstract: This paper reported on the health status and 
service utilization of patients with arthritis 
at a comprehensive health care center in 
Brooklyn, New York, and the activities devel- 
oped to improve outpatient care to them. His- 
panics and non-Hispanic adult arthritis pa- 
tients health status and service utilization 
were compared. Of the patients with joint 
disease, 69% were Hispanic, 62% were on Medi- 
care, Medicaid, or both; 35% qualified for 
minimum fee on the basis of income, and 3% had 
private insurance. The population was urban 
and low income. Spanish language was used at 
intake by trained bilingual interviewers and 
in the field by field workers. References. 



132. Author: Keane, J. R. (1984). 

Title: Death from cysticercosis — seven patients with 
unrecognized obstructive hydrocephalus. 

Source: The Western Journal of Medicine , 140 (5) , 787- 
789. 

Abstract: Case reports of seven patients at Los Angeles 
County USC Medical Center are reported in 
detail. Although cysticercosis has been 
largely eliminated in the U.S., it is pandemic 
in Mexico, Central, and South American. With 
increased immigration from those regions, 
cysticercosis is becoming a common disease in 
the Southwest. The seven cases were Latin 
American patients. Most had repeatedly sought 
medical attention because of severe headache 
and vomiting. Until irreversible brain-stem 
compression occurred, most were considered to 
have benign vascular headaches. Occasional 
symptoms of syncope, fleeting diplopia and 
transient unilateral numbness were reported. 5 
References. 



133. Author: Kerr, G. R. , Amante, P., Decker, M. , & Callen, 

P. W. (1982) . 
Title: Ethnic patterns of salt purchase in Houston, 

Texas. 
Source: American Journal of Epidemiology , 115 ,906-916. 
Abstract: An indirect measure of sodium intake for 

Black, White, and Hispanic populations of 



148 



Houston, Texas, was derived from an examina- 
tion of warehouse orders received over a six- 
month period from a chain of 52 stores in the 
area. For each store, both direct salt pur- 
chases and the salt content of 20 dietary 
staple items were recorded. The ratios be- 
tween the sales of salt and each food com- 
modity in each store were then examined in 
relation to the ethnic characteristics of the 
census tracts in which the store was located. 
Stores located in census tracts that had more 
than 50% of any of the Black, White, or His- 
panic population were compared. The mean 
ratios between salt and the food staple com- 
modities in the predominantly Black and His- 
panic census tract supermarkets were 148% and 
2 02%, respectively, of that in predominantly 
White census tract supermarkets. Sales of 
table salt are 50-100% higher in Black and 
Hispanic census tract supermarkets than in 
those of White census tracts. It is not known 
if the increased sales of table salt have 
causal relationship to the prevalence of 
hypertension in those communities, but this 
study indicates higher salt usage. 64 Refer- 
ences. 



134: Author: Kerr, G. R. , Amante, P., Decker, M. , & Callen, 

P. W. (1983) . 

Title: Supermarket sales of high-sugar products in 
predominately Black, Hispanic, and White 
census tracts of Houston, Texas 

Source: The American Journal of Clinical Nutrition , 37 
(April), 622-631. 

Abstract: The purpose of this study was to analyze 
supermarket sales of sweet foods in comparison 
to staple foods to determine if changes in 
nutrient consumption are related to changes in 
socioeconomic and demographic factors. Records 
of sales of 488 sweet foods (SE) and 21 sta- 
ples (C) were examined in 48 supermarkets 
located in predominately Black, Hispanic, and 
White census tracts in Houston, Texas. The 
mean sweet energy/commodity food sales ratios 
in the Black (122%) and Hispanic (108%) were 
higher than those in the White census tracts. 
Although ethnic differences in sweet energy/ 
commodity sales ratios were almost always 
significant, variations within ethnic super- 
markets remained large, indicating nonethnic 
factors also influenced food purchase pat- 
terns. High sucrose products (SE) were aggre- 
gated into six categories: dry sugars, liquid 



149 



sugars, fruit preserves, candy, sucrose- or 
fructose-containing beverages, and miscella- 
neous sweet products. The energy content of 
each sweet product was analyzed and calculated 
separately for each supermarket. Total sales 
of SE of each supermarket were examined in 
relation to sales of each of 20 staple food 
commodities (C) , and SE/C ratios calculated 
for each of the three ethnic groups of super- 
markets. It is suggested by the authors that 
supermarket sales records offer an inexpensive 
source of data for comparative or longitudinal 
studies of community purchase of food products 
which may play a role in the development of 
nutrition associated with health problems. 
The major problems in interpreting the data 
are a need to use ratios and lack of a valid 
measure of the population consuming the food 
purchased. 56 References. 



135. Author: 
Title: 
Source: 
Abstract: 



Langrod, J., Alksne, L. , Lowinson, J., & Ruiz, 
P. (1981) . 

Rehabilitation of the Puerto Rican addict: A 
cultural perspective. 

The International Journal of the Addictions , 
16(5), 841-847. 

Drug dependence ranks among the leading causes 
of death among Puerto Ricans of all ages. This 
study describes 162 Puerto Rican patients in a 
drug rehabilitation program in a New York city 
clinic of the Albert Einstein College of Medi- 
cine Substance Abuse Service. A questionnaire 
was self-administered. Two social factors 
perceived as relating to rehabilitation 
efforts are the patient's employment status 
and educational levels at the time of admis- 
sion. Only 3% were employed and 17% were High 
School graduates. Seventy one percent of the 
Puerto Rican group were retained in treatment 
over a 2 -year period; this is comparable with 
retention in treatment for non-Hispanic 
patients in the program. Also, Methadone main- 
tenance treatment was found to be beneficial 
in the reduction of criminal behavior after 
entry into treatment. Moreover, if Hispanic 
addicts are to be rehabilitated, treatment 
personnel must understand not only the key 
values of dignity and respect inherent in the 
culture, but also the circumstances which 
threaten that culture. These circumstances 
include geographic mobility making extended 
family ties difficult to maintain, the confu- 
sion created by challenges to the traditional 



150 



authority vested in the male head of a His- 
panic household and stress caused by pressure 
to conform to American customs which often 
denies or contradicts their own cultural 
values. 6 References. 



136. 



Author : 
Title: 



Source: 
Abstract: 



Lawlis, G. F. , Achterberg, J., Kenner, L. , & 
Kopetz, K. (1984) . 

Ethnic and sex differences in response to 
clinical and induced pain in chronic spinal 
pain patients. 
Spine , 9(7), 751-754. 

There is widely held clinical opinion and some 
tentative research justification for stero- 
typic or ethnic and sex differences in respon- 
se to pain. To more adequately test this 
notion, 60 Texas chronic spinal pain patients 
(Black, Mexican American, and Caucasian, with 
ten men and ten women per group) , all having 
persistent spinal pain for over 1 year, were 
studied. They were administered the ischemic 
pain test (a psychophysiologic scaling tech- 
nique used to approximate clincal pain and 
pain tolerance) , a numerical estimate of spi- 
nal pain, and two independent rates scaled the 
amount of pain emphasis, based upon the pa- 
tient's physical condition and pain behaviors. 
Results showed that when pain was assessed by 
multiple measures in a sample of spinal pain 
patients, Mexican Americans tended to identify 
their spinal pain as being significantly 
greater than did Caucasians when the ischemic 
pain match was used. Women of all ethnic 
groups tended to be judged as emphasizing 
their pain more than men, based upon judgment 
of their pain behaviors, and upon their own 
numerical estimates of pain. They also indi- 
cated that they more nearly approached their 
pain tolerance. It was concluded that while 
ethnic and sex differences were found, stereo- 
typic responses were not uniform, and tended 
to be related to the manner in which the pain 
was assessed. These results are discussed in 
light of cultural differences. 23 References. 



137 



Author : 
Title: 

Source: 



Abstract: 



Leland, J. (1984) . 

Alcohol use and abuse in ethnic minority 

women . 

In S. C. Wilsnack & L. J. Beckman. (Eds.), 

Alcohol Problems in Women, (pp. 69-96) . New 

York: The Guilford Press. 

This is a review of the available alcohol- 



151 



related literature comparing women of various 
U. S. minority groups, primarily, Black, His- 
panic, and Indian, with women in the general 
population. Topics covered in the review 
include: prevalence of alcohol use and abuse, 
youth and adult drinking patterns, adult 
drinking contexts, health and social conse- 
quences, support systems, sex roles and utili- 
zation of and response to treatment. The 
author notes difficulties engendered by small 
sample sizes, lack of comparable measurement 
criteria, and absence of data, especially for 
Hispanic and Asians. 99 References. 



138. Author: Levenson, P. M. , Pfefferbaum, B. J., Copeland, 

D. R. , & Silberberg, Y. (1982). 

Title: Information preferences of cancer patients 
ages 11-20 years. 

Source: Journal of Adolescent Health Care , 2C 1 ) / 9~13. 

Abstract: A written questionnaire was used in this study 
to determine sources of information preferred 
by 63 adolescent cancer patients 11-20 years 
old. The most common source was the private 
physicians. More than half preferred private 
discussion with a health professional, while 
68% wanted physicians as the preferred choice. 
Parents were included in the discussion by 
68%, while only 35% indicated that additional 
information might be helpful. That families 
(42%) and friends (45%) should have more in- 
formation was indicated by the respondents . 
Findings showed no apparent relationship be- 
tween diagnosis or sex and the patients 1 an- 
swers. Physicians as their main information 
sources or additional information was not the 
wish of newly diagnosed patients. Those who 
were actively ill also were not as interested 
in additional information. Younger patients 
tended to avoid group discussion, wanted the 
information only from their parents, and did 
not want their friends to receive additional 
information. Hispanics were most likely to 
request additional information for parents and 
that their parents be included in discussions. 
(Authors abstract modified.) 

I.D.No.: 22G 



139. Author: 
Title: 



Source: 



Lindholm, K. J., & Willey, R. (1983). 

Child abuse and ethnicity: Patterns of simi- 

liarities and differences. (Occasional paper 

No. 18) . 

Spanish Speaking Mental Health Research 

Center , Los Angeles, California: UCLA. 



152 



Abstract: A total of 4,132 cases of child abuse that 
were reported to the Los Angeles County 
Sheriff's Department were analyzed to deter- 
mine whether there were differences related to 
the ethnic group status of the victim or sus- 
pect. Results demonstrated that there were a 
number of significant differences attributed 
to ethnic group status. Comparing the ethnic 
group distribution of reported cases with that 
of the population in the county showed that 
Anglos and Hispanics were underreported with 
respect to their representation in the popula- 
tion whereas Blacks were overrepresented. 
Among suspects, males (especially fathers) 
were the more frequent suspects in Anglo and 
Hispanic families, although females (and 
mothers) were the suspects most often in Black 
families. Physical abuse was highest in Black 
families, with discipline most often given as 
the reason for the abuse. On the other hand, 
physical abuse was nearly equivalent for His- 
panic and Anglo families. There were also 
differences in the types of physical injuries 
that the children suffered as a result of the 
abuse. Black children were most likely to be 
whipped/beaten and to receive lacerations/ 
scars, whereas Anglo children most often ob- 
tained bruises. Hispanic and Anglo children, 
especially females, were much more likely to 
be sexually abused than were Black children, 
with sexual preference more frequently given 
to Anglo and Hispanic male suspects as the 
reason for abuse. Finally, there were also 
differences in the informant of the abuse, 
with schools more often reporting Hispanics, 
hospitals informing on Blacks, and family 
members informing on Anglos. It was concluded 
that cultural differences need more systematic 
research attention in studies of child abuse. 
(Author abstract.) 17 References. 



140. Author: Lopez, L. (1985, February 17). 

Title: The Mexican American with non-insulin depend- 
ent diabetes mellitus-an epidemiological 
report . 

Source: Paper presented to the Task Force on Black and 
Minority Health, Bethesda, Maryland. 

Abstract: The purpose of this paper is to present an 
epidemiological perspective of diabetes among 
Mexican Americans. The author discusses the 
incidence of diabetes and the accumulating 
evidence of its being a major health problem 
for this population. The effect of socio- 



153 



economic status on diabetes prevalence as well 
as that of acculturation are factors further 
mentioned. Health beliefs among family mem- 
bers are also thought to contribute to the 
incidence. Risk for diabetes is presented 
particularly in San Antonio, Texas. The impli- 
cations for nursing include: further research 
needed, acknowledgement and understanding of 
cultural practices and beliefs, health educa- 
tion, in particular the development of mater- 
ials for teaching in Spanish that are cultur- 
ally sensitive to the specific needs of Mexi- 
can Americans. 9 References. 



141. Author: Lopez-Agueres, W. , Kemp, B., Plopper, M. , 

Staples, F. R. , & Brummel-Smith, K. (1984). 

Title: Health needs of the Hispanic elderly. 

Source: Journal of the American Geriatrics Society , 3_ 
(March), 191-198. 

Abstract: The purpose of this paper was to review the 
health needs of the Hispanic elderly in Los 
Angeles County. The sample included 1,000 
noninstitutionalized elderly persons 60 years 
and older. The study used a multistaged area 
probability sample stratified by city and 
Hispanic population density. The instrument 
used in the study was the Comprehensive As- 
sessment and Referral Evaluation, a multi- 
disciplinary, semistructured personal inter- 
view guide that covered psychiatric, medical, 
functional, nutritional, economic, and social 
problems of older adults. A total of 704 
interviews were obtained: 299 male and 404 
female. The findings indicated that older 
Hispanics were affected by cognitive impair- 
ment (13.8%), depression/demoralization 
(30.8%), heart disorders 12.8%), stroke ef- 
fects (11.5%), arthritis (28.3%), hypertension 
(23.7%), financial hardship (28.0%), fear of 
crime (38.4%), ambulation problems (17.2%), or 
activity limitation (24.7%). They also needed 
assistance (19.3%) or used social services 
(22.0%). Additional analysis demonstrated 
that the prevalence of many of these problems 
varied significantly according to the age, 
sex, language and income of respondents. The 
indicators of health care needs that this 
study utilized were different from the more 
traditional measures based on the person's own 
perception of his or her health. 25 Referen- 
ces. 



154 



142 



Author : 
Title: 



Source: 
Abstract: 



Lorig, K. R. , Cox, T., Cuevas, Y. , Kraines, R. 
G., & Britton, M. C. (1984). 

Converging and diverging beliefs about arth- 
ritis: Caucasian patients, Spanish speaking 
patients, and physicians. 

The Journal of Rheumatology , 1^.(1), 76-79. 
A sampling of arthritis patients undergoing 
treatment at Stanford Arthritis Center was 
taken, consisting of 98 Caucasians, 46 Spanish- 
speaking patients and 50 physicians (mainly 
rheumatologists) . Caucasian patients were 
asked about beliefs regarding arthritis and 
its treatment. The physicians were given the 
same items. There was a great degree of simi- 
larity between the two sets of responses. 
However, when physicians perceptions of Cau- 
casian patients' beliefs were matched against 
the patients 1 actual responses, there was a 
great divergence. The authors summarize that 
for Caucasian patients and physicians the 
beliefs are similar: Physician generally 
underestimate the knowledge and beliefs of 
their patients in traditionally proven treat- 
ments; physicians overestimate patient be- 
liefs in non-traditional therapies. The 
Spanish-speaking sample was quite hetero- 
ogeneous, 45% born in Mexico, 27% in Central 
America, 10% from South America, and 16% U.S. 
born. The foreign born had been resident in 
the U.S. from one to more than 20 years. This 
sub-sample ' s responses were compared only to 
the Caucasian patients 1 : physicians were not 
asked about their perceptions of Spanish- 
speaking patients' belief. Spanish-speaking 
patients differed from Caucasian in reporting 
inflammation as a problem caused by arthritis, 
and in the use of massage as treatment. While 
equal numbers of both groups mentioned diet, 
the Spanish-speaking responses were uniform 
that pork and red meats caused problems, 
whereas there was no such pattern in Cauca- 
sian responses. 7 References. 



143. Author: Maddux, J. F., & Desmond, D. P. (1981). 

Title: Opioid use in San Antonio. 

Source: Careers of opioid users , (pp. 31-46), New York: 
Praeger Press. 

Abstract: This article is a historical view of the 
growth and development of San Antonio, the 
evolvement of the Mexican Americans in San 
Antonio, and the evaluation of the drug trade 
in this geographic area. The author begins by 
describing the founding of San Antonio and the 



155 



growth of the city. The influence of the 
Mexican Revolution of 1910 and two world wars 
is presented. The mixed Indians, European, 
and Mestizo background is introduced. Histori- 
cal conditions which influenced status and 
attitudes toward Mexican Americans is in- 
cluded. The Bracero Program and the effects 
of the civil rights movement of the 1960s are 
discussed. The author next describes the 
development of opioid use in San Antonio. 
Subjects and police officials interviewed 
reported that heroin use began during the 
1930s in San Antonio and was initially asso- 
ciated with the red-light district and the 
race track. During the 1950s and early 1960s, 
Mexican American juvenile gangs in the west- 
side had serious group fights. While gangs 
engaged in drinking beer and smoking mari- 
juana, heroin use was not approved. However, 
by 1956, ten years after the end of World War 
II, San Antonio had become a center for illi- 
cit heroin traffic. By the 1970s, the heroin 
traffic from Mexico to the U.S. had become 
organized into an extensive and complex crimi- 
nal business. Several large Mexican families 
with relatives and friends in San Antonio, Los 
Angeles, Chicago and other cities managed 
production and distribution networks. After 
1950, an increase effort by federal, state and 
local law enforcement agencies occurred in 
order to try to reduce the drug traffic. The 
final section of this report discusses street 
heroin and treatment programs. Variations in 
heroin potency and packaging for distribution 
are described. Since 1966, availability of 
treatment programs has increased. Programs 
currently available are introduced. 29 Ref- 
erences. 



144 



Author : 
Title: 

Source: 



Abstract: 



Marcus, A. R. , & Crane, L. A. (1984). 
Smoking behavior among Hispanics: A prelimin- 
ary report. 

In P. E. Engstrum, H. Anderson, & Mortenson 
( Eds . ) . Advances in Cancer Control : Epidemio- 
logy and Research (pp 141-151) . New York: 
Alan R. Liss, Inc. 

The purpose of this review was to report on 
available data concerning the smoking patterns 
of Hispanics. An analysis was made of smoking 
rates by race and ethnicity, sex, age, and 
smoking behavior among Hispanic youth. Find- 
ings indicated that Hispanics appear to have a 
lower smoking rate (32.%) than either 



156 



White/Anglo (37.1%) or Blacks (39.4%). When 
stratified by sex, smoking rates among males 
appear similar across groups. Hispanic men 
have a slightly higher rate (41.5%) than 
White/ Anglo (39.3%) and Blacks (40.0%). His- 
panic women have lower rates (27.4%) than 
either White/Anglos (35.2%) or Black women 
(39.0%). Thus, it appears that the lower 
prevalence of smoking among Hispanics is due 
to the smoking behavior of Hispanic women. 
Hispanic men seem to be smoking at least as 
much as White and Black men. When both sexes 
and all ages are combined, smoking rates are 
slightly lower for Hispanics than for 
White/Anglos or Blacks. When stratified by age 
and sex, a different view is characterized. 
For all females under 65, Hispanic smoking 
rates are 5 to 10 percentage points lower than 
rates for White/ Anglos. The difference is 
greater between Hispanic and Black women. 
Hispanic men between 35 and 64 have slightly 
higher smoking rates than White/Anglo men and 
slightly lower than Black men. Among Hispanic 
youth, the data shows a higher rate of "ever 
smoked" and "currently smoking" for Hispanics 
when compared to Anglo and Black children. 
The results of the data reviewed suggest a 
hypothesis that runs counter to current think- 
ing. The authors believe that rates of His- 
panic lung cancer may sharply increase within 
this decade and continue to increase into the 
next century. 13 References. 



145. Author: Marcus, A. C, & Crane, L. a. (1985). 

Title: Smoking behavior among U.S. Latinos: an emer- 
ging challenge for public health. 

Source: American Journal of Public Health , 75(2) , 169- 
172. 

Abstract: The purpose of this review was to discuss evi- 
dence on smoking and lung cancer among Latinos 
in California, Texas and New Mexico. Data 
reviewed included findings from several unpub- 
lished studies and technical reports. Latino 
males were found to smoke as frequently as 
White males. Latina females smoked at a lower 
rate than White females. An analysis of 1979 
and 1980 National Health Interview Survey 
corroborated these findings and further indi- 
cated that the pattern held for Latino sub- 
groups. Based on the findings, it was sugges- 
ted that rates of lung cancer and other 
cigarette- linked diseases among Latino males 
may increase within this decade and continue 



157 



to increase into the next century, 
erences. 



14 Ref- 



146. Author: 



Title: 
Source: 



Abstract: 



Merritt, R. J., Coughlin, E., Thomas, D. W. , 
Jariwala, L. , Swanson, V., & Sinatra, F. R. 
(1982) . 

Spectrum of ambeiasis in children. 
American Journal of Diseases in Children , 136 
(September). 785-789. 

The purpose of this article is to document the 
need for considering amebiasis in the differ- 
ential diagnosis of infants and children with 
hematochezia or hepatomegaly, especially in 
endemic areas. In eleven patients with child- 
hood amebiasis, only two exhibited dysentery. 
Additonal clinical symptoms included hemato- 
chezia without diarrhea (4 patients) , dysen- 
tery with appendicitis (one patient) , exacer- 
bation of ulcerative colitis (2 patients) , and 
disseminated infantile amebiasis (2 patients) . 
All patients who manifested hematochezia when 
examined by proctosigmoidoscopy exhibited co- 
litis. Amebiasis was diagnosed by microscopic 
examination of fresh stool specimens, path- 
ologic findings, and/or serologic titers. All 
but one of the patients had a Spanish surname 
or at least one Spanish-speaking parent. None 
of the children had a history of recent 
foreign travel. The one non-Hispanic patient 
had been exposed to a maid who had recently 
returned from Central America. Since the 
Southwest and Central America are know endemic 
areas for amebiasis, the suspicion for this 
condition must be high in patients with Span- 
ish surnames who have hematochezia. The di- 
sease is particularly frequent in the Mexican 
American population. Amebiasis is the fourth 
most common cause of death in Mexico City. 
Based on the findings among the cases discus- 
sed, the authors recommended that if routine 
stool cultures and at least three stool exami- 
nations for ova and parasites are negative, 
all such patients should have a proctosig- 
moidoscopic examination and a fresh stool 
specimen examined for E histolytica. An ame- 
bic titer by IHA should be obtained if colitis 
is present and the stool examination and cul- 
tures are negative. 21 References. 



147. Author: 
Title: 



Miller, B. L. , Goldberg, M. A., Heiner, D., & 

Myers, A. (1983) . 

Cerebral cysticercosis: An overview. 



158 



Source: Bulletin of Clinical Neurosciences , 48 , 2-5. 

Abstract: The purpose of this paper is to briefly dis- 
cuss the epidemiology, parasitology, and 
clinical features of cysticercosis. Currently 
available immunologic lists and those present- 
ly under investigation are also presented. 
Cysticercosis is becoming increasingly im- 
portant to medical doctors in the United 
States, particularly those working with Mexi- 
can Americans. With the increasing number of 
immigrants from endemic areas arriving in 
Southern California, it is possible that na- 
tive Californians will become infected by 
eating food contaminated with eggs from the 
stool of infected patients. The clinical 
diagnosis of this condition depends on a com- 
bination of clincal suspicion, radiographic 
studies, and immunological confirmation. 10 
References. 



148. Author: Miller, B. L. Heiner, D. , & Goldberg, M. A. 

(1981) . 

Title: The immunology of cerebral cysticercosis. 

Source: Bulletin of Clinical Neurosciences , 48 , 18-23. 

Abstract: While cysticercosis has been a rare disease in 
the United States, it is prevalent in Mexico, 
Central and South American. The recent immi- 
gration from those areas has resulted in many 
cases of cysticercosis in the U.S. A protocol 
for examination of suspected cysticercosis 
cases is presented, including a description of 
the life cycle, a clinical course, and a lis- 
ting of immunological tests. Protocol was 
developed from Mexican patients in Los 
Angeles. 22 References. 

149. Author: Miller, B. , Goldberg, M. A., Heiner, D. , 

Myers, A., & Goldgerg, A. (1984). 

Title: A new immunologic test for CNS cysticercosis. 

Source: Neurology , 3_4 (5) , 695-697. 

Abstract: This study carried out in the Los Angeles area 
sought improved techniques for diagnosing 
cerebral cysticercosis. The manifestations of 
this disease can be classified under three 
pathologic entities: (1) cortical cysts, (2) 
ventricular cysts, and (3) meningitis. Cere- 
bral cysticercosis is endemic in Mexico and 
throughout Central and South America and is 
being noted with increasing frequency in immi- 
grant populations throughout the Southwest. 
The new radioimmunoassay for cerebral cysti- 
cercosis was studied in 70 patients almost all 



159 



of whom were Mexican American. The assay 
showed nearly 100% sensitivity for ventricular 
cysts or meningitis, 86% sensitivity for 
multiple parenchymal cysts, and a false- 
positive rate of 7%. Both serum and CSF anti- 
body levels were useful diagnostically, and 
the contribution of both improved accuracy. 
In some patients, there was endogenous CNS 
production of IgG against the cysticercus 
antigen, which leads to elevated CSF levels 
and normal serum levels. Patients with high 
CSF total IgG levels may show false-positive 
CSF antibody elevation with normal serum 
levels. Although a formal study is needed the 
new radioimmunoassay is an improvement over 
earlier diagnostic tests. 9 References. 



150. Author: Miller, B. , Grinnell, V., Goldberg, M. A. , & 

Heiner, D. (1983) . 

Title: Spontaneous radiographic disappearance of 
cerebral cysticercosis: Three cases. 

Source: Neurology , 33(10), 1377-1379. 

Abstract: Cerebral cysticercosis is prevalent throughout 
Mexico and has become more prevalent in 
clinics in the Southwest serving Mexican immi- 
grants. This article illustrates the sponta- 
neous resolution of three cases of cerebral 
cysticercosis. The patients were 2 Mexican 
adult women and one Mexican adult male. A 
short history on the evolution of the disorder 
is provided. The authors emphasize the need 
for controlled studies on the benign course of 
cerebral cysticercosis. Furthermore, they 
indicate that the benign course of the disease 
should be considered prior to surgical inter- 
vention or institution of other treatments. 7 
References. 



151. Author: Nace, R. P. (1984). 

Title: Epidemiology of alcoholism and prospects for 
treatment . 

Source: Annual Review of Medicine , 35 , 293-309. 

Abstract: This article reviews current epidemiological 
studies of alcoholism among five subgroups 
within the American population: older adults, 
adolescents, women, Blacks and Hispanics. 
Also, prospects regarding treatment outcome 
are discussed. The epidemiological method- 
ology provides data that a) document national 
drinking practices across decades and indicate 
no marked changes in drinking practices for 
the past decade; b) allow a quantification of 



160 



the frequency of alcohol related problems; and 
c) illustrate the relationship between quan- 
tity, frequency, and pattern of alcohol use 
and the symptoms of alcohol dependence. Among 
adults who drink, an alcoholism prevalence 
rate of nearly 8% is expected. When subgroups 
within the population are examined, women are 
found to have a lower rate of alcoholism than 
men. There are indications that Blacks and 
Hispanics exceed the general population in 
prevalence of alcoholism, although the data 
was incomplete in this regard. About a third 
of Hispanic women are abstainers, a rate three 
times that of Hispanic men. Among Hispanics 
being young, single or divorced is associated 
with more drinking for both sexes. The pros- 
pect for treatment for all of the above sub- 
groups is highly favorable. Among Hispanics, 
though, a major problem is the underutiliza- 
tion of treatment facilities. Cultural factors 
are offered as a means to explain the under- 
utilization. 60 References. 



152: 



Author : 
Title: 

Source: 
Abstract: 



Navarro, J. D. (1981) . 
The family and child 



abuse in 



Latino 



Community . 

California: J. W. Gaterman & Associates. 
The purpose of this study was to compare 
factors which cause child abuse that occur 
within a culturally unique low socioeconomic 
community with established criteria in order 
to describe the characteristics of families 
prone to child abuse. The study population 
was predominantly Mexican American from East 
Los Angeles. The sample consisted of thirty 
cases. It was hypothesized that differences 
existed between causative indicators of child 
abuse within the sample and those factors 
reported in research and survey studies. It 
was furthere hypothesized that differences in 
causative factors also existed between Mexican 
Americans and Mexicans. Methodology included 
an empirical case approach in order to thor- 
oughly examine possible causative factors in 
identified cases of child abuse by persons of 
Mexican and Mexican American heritage. Detail- 
ed demographic and sociological data were 
collected. Also included were data on inter- 
generational influences, social isolation, 
personality deficits and environmental causa- 
tion. Statistical analysis utilized both 
parametric and non-parametric techniques. The 
findings supported the relationship between 



161 



socioeconomic factors and child abuse in this 
sample. With respect to psychological fac- 
tors, it was found that while the respondents 
had emotional problems, they did not fall 
under the category of psychosis. The sample 
did not corroborate an intergeneration learned 
behavioral view of child abuse. With respect 
to social isolation as contributing to child 
abuse, the sample did not support this view. 
Seventeen (56.6%) of the entire sample lived 
in a legal or common law man and wife arrang- 
ment. In looking at within-group differences 
between Mexicans and Mexican Americans, it was 
found that overall the Mexican group was bet- 
ter off financially than the Mexican American 
group. More Mexicans versus Mexican Ameri- 
cans experienced emotional and interpersonal 
problems. Both groups reported happy and 
memorable relationships with parents. In 
looking at social isolation, while the Mexican 
groups revealed greater family unity existed, 
this did not necessarily eliminate isolation. 
The physical presence of people in the home 
did not necessarily mean positive family 
interaction nor an existing support system. 
The Mexican group was at greater risk for 
isolation with its recency of arrival, lack of 
formal education, formal support systems, and 
fear of law officials. 81 References. 



153. Author: Newell, G. R. , & Boutwell, W. B. (1981). 

Title: Cancer differences among Texas ethnic groups — 
an hypothesis. 

Source: The Cancer Bulletin , 33 (3), 113-114. 

Abstract: This report presents a hypothesis that differ- 
ences in cancer rates in ethnic populations 
are related to diet and nutrition. Reducing 
cancer of the breast and colon by changing 
eating habits would provide a new approach to 
preventing such cancers. In south and south- 
west Texas, the Spanish-surname population 
consistantly has the lowest rates for breast 
and colon cancers, with Whites having the 
highest rates. Statistics report a sharp 
increase in breast and colon cancer after 
premenopausal age among Whites and Blacks, 
while Spanish-surnamed persons show no peak in 
rates but a constant increase and have a lower 
rate than Whites or Blacks in all groups. The 
role of fat, starch and fiber consumption is 
discussed. The authors suggest two studies 
as a new approach for the prevention of breast 
and colon cancer: 1) a survey of the general 



162 



population in the selected areas to determine 
eating habits and other risk factors by ethnic 
groups, and 2) a concurrent case-comparison 
investigation of the etiologic importance of 
suspected food and eating patterns in the 
incidence of breast and colon cancer. 7 
References. 



154. Author: 
Title: 



Source: 



Abstract: 



Ortega, A. (1982, September). 

An education program designed to prepare the 
Spanish speaking pregant woman for the experi- 
ence of fetal monitoring . 

Paper presented at the meeting of the National 
Association of Hispanic Nurses, Los Angeles, 
California. 

A protocol for an educational program to pre- 
pare Spanish-speaking women for the experience 
of fetal monitoring. Developed for Santa 
Clara Medical Center in San Jose, in which 
institution 46% of the births were to Spanish- 
surnamed women. About half were monolingual 
Spanish-speaking, tended to be immigrant women 
from small rural towns in Mexico, experiencing 
their first birth. These women have risk 
factors which make them high-risk category 
patients: poor nutrition, seeking care late, 
inappropriate weight loss or gain, low income, 
and others, which make electronic fetal moni- 
toring (EFM) indicated. Reports of Mexican 
immigrant women's fears about EFM are given. 
These fears indicate monitoring is a stressful 
experience. The proposed teaching situation 
includes: individual teaching using photo- 
graphs and a pamphlet in Spanish illustrating 
monitoring, inclusion of EFM information into 
the content of Spanish-speaking group prenatal 
classes, demonstration of EFM equipment and 
procedures during a tour of the maternity unit 
for the Spanish-speaking woman. 47 References, 



155, 



Author: 
Title: 



Source: 



Abstract: 



Ortiz, J. S. (1980) . 

The prevalence of intestinal parasites in 
Puerto Rican farm workers in western Massa- 
chusetts . 

American Journal of Public Health, 70(10) , 
1103-1105. 

Parasitic examination was done for stool 
samples of 377 Puerto Rican subjects. 281 
subjects had been born in Puerto Rico, and had 
been on the mainland U.S.A. for an average of 
one year and 11 months. 96 subjects were born 
in the U.S. All were farm workers residing 



163 



in the area of Holyoke, Massachusetts, of 
which 152 were children. Of all stool samples, 
35.5% were positive for parasites. The rate 
for native born was 30%, and for foreign born, 
37%, statistically insignificant. These infes- 
tation rates are higher than have been report- 
ed in eariler studies. 16 References. 



156. Author: Patterson, R. M. , Hayashi, R. H. , & Cavazos, 

D. (1983). 

Title: Ultrasonographically observed early placental 
maturation and perinatal outcome. 

Source: American Journal of Obstetrics and Gynecology , 
December , 773-777. 

Abstract: The purpose of this study was to 1) define the 
relationship of ultrasonographically observed 
placental maturation to gestational age in a 
large homogenous population, 2) establish a 
definition of early placental maturation for 
this population, and 3) evaluate the sign' 
cance of early maturation with respect _o 
perinatal outcome. All nondiabetic Spanish- 
surnamed patients with singleton gestations 
that demonstrated either a Grade II or Grade 
III placenta were retrospectively selected for 
study. Perinatal outcome in 398 patients was 
analyzed in a cross-sectional study. Statisti- 
cal analysis was done by means of an unpaired 
two-tailed t test and chi square test. Find- 
ings indicated a trend toward lower mean birth 
weights in the group identified with early 
placental maturation as compared to controls. 
Statistical significance was achieved in the 
Grade II population. With the Grade III popu- 
lation, early placental maturation identi- 
fied a group of patients with 16.7% incidence 
of growth retardation as compared to 4.1% in 
control patients. Early placental matura- 
tion was found to be an insensitive predictor 
of poor perinatal outcome with respect to 
maternal hypertension, antepartum or intrapar- 
tum fetal distress, and prenatal asphyxia. 10 
References. 



157. Author: 

Title: 

Source: 

Abstract: 



E., 
P., 



Brown , A . S . , 
Atkins, H. G. , 



Roberts, W. R. , 
& Robinowitz, R. 



Penk, W. 

Dolan, M. 

(1981) . 

Visual memory of male Hispanic American heroin 

addicts. 

Journal of Consulting and Clinical Psychology , 

49(5), 771-772. 

A comparative testing of impaired visual memo- 



164 



ry, as detected by the Revised Benton Visual 
Retention Test, given 55 Hispanic (nationality 
unspecified) heroin addicts. Test results 
were compared with Blacks and Whites. Data 
show that Hispanics display interferences in 
visual memory and that Hispanic visual memory 
is more comparable to Blacks than Whites. 
Questions are raised about establishing norms 
for minorities on neuropsychological tests. 5 
References. 



158. Author: Pockros, P. J., Peters, R. L. , & Reynolds, T. 

B. (1984). 

Title: Idiopathic fatty liver of pregnancy: Findings 
in ten cases. 

Source: Medicine , 62(1) , 1-11. 

Abstract: This study concerned the incidence of Fatty 
liver of pregnancy (FLP) disorder. FLP is a 
disease causing jaundice in the third trimes- 
ter of pregancy resulting in hepatic failure, 
bleeding diathesis and coma. FLP had received 
widespread attention because of high mortality 
of mother and infant. Using records obtained 
at the Los Angeles County-University of South- 
ern California Medical Center for the period 
1972 to 1982, ten cases of FLP are reported of 
which nine are Hispanic women and the other 
Black. Compared to earlier reports, a marked 
decrease in both maternal and fetal mortality 
was noted: only one mother died and 2 of 12 
infants were stillborn. Eight other cases 
obtained from liver biopsies referred from 
other hospitals were also reviewed and com- 
bined mortality data were similar. Since deli- 
very was spontaneous in 8 of the 10 patients, 
the lower mortality cannot be attributed to 
early delivery. Instead, the authors ascribe 
it to improved supportive therapy with 
transfusions, clotting factors, antibiotics, 
glucose and monitoring. New data concerning 
presenting signs and symptoms, laboratory 
features including serial clotting screens 
documenting disseminated intravascular coagu- 
lation (DIC) , obstetric and perinatal informa- 
tion as well as maternal follow-up are 
presented. Although 9 of the women in this 
study were Hispanic and none Caucasian, this 
reflects the ethnic/racial composition of 
patients at the medical institution. It is 
doubtful that ethnic factors affect incidence 
or outcome of FLP. 36 References. 



165 



159. Author: Poma, P. A. (1984). 

Title: A dangerous folk therapy. 

Source: Journal of the National Medical Association , 
76(4), 387-389. 

Abstract: The purpose of this paper was to examine the 
risk of severe lead poisoning that Hispanic 
and other minority children undergo when given 
traditional ethnic remedies. The use Azarcon 
for "empacho" among Hispanic families has been 
linked to severe lead poisoning. Based on the 
findings, it is recommended that all children 
be screened at least every one to two years. 
Migrant children in particular are at risk and 
therefore should be screened yearly and those 
at obvious risk every two to three months. 
This is particularly crucial to those who have 
newly arrived, are transient, and distanced 
from health care by language, socioeconomic 
status, and cultural beliefs. 9 References. 



160. Author: 

Title: 
Source: 

Abstract: 



Powell, K. E., Meador, M. P., Farer, L. S. 
(1984) . 

Recent trends in tuberculosis in children. 
The Journal of the American Medical Associa- 
tion , 251 , (10), 1289-1292. 

A study by the Center for Disease Control 
which charts the progress of the incidence of 
tuberculosis in children across the country 
from 1962 through 1981. Using national morbi- 
dity data, the study particularly examines the 
failure of the incidence of tuberculosis to 
decline from 1976 through 1981, and seeks to 
identify the factors responsible. The study 
concludes that the stability of incidence of 
tuberculosis among Whites was caused by an 
increase among Hispanics, and the stability 
among other races was caused by an increase 
among Indochinese refugees. 7 References. 



161. Author: Ramirez III, M (1983). 

Title: Cultural and individual differences in alco- 
hol, drug abuse, and mental health research. 

Source: In ISLAS Inc., (Ed.), Hispanics and health 
research in the Public Health Service : Public 
health research issues , (pp. 16-28). Rockville, 
Maryland: United States Department of Health 
and Human Services. Public Health Service 
(Hispanic Employees Organization) . 

Abstract: The purpose of this paper was to summarize the 
major points made on a review of research done 
with Hispanic groups in the United States 
between 1971 and 1981. Sixty-nine Hispanic 



166 



projects were reviewed focusing on the Mexican 
American (53%) , Puerto Ricans (43%) , and Cuban 
American (6%) populations. These projects 
were funded by the National Institute of Men- 
tal Health (85%) , the National Institute on 
Drug Abuse (14%) and the National Institute on 
Alcohol Abuse and Alcoholism (one project) . 
Six major research themes were identified by 
the reviewer. These included: 1) the develop- 
ment and implementation of mental health ser- 
vices consonant with the cultures of the var- 
ious Hispanic groups, 2) the identification 
and utilization of supportive resources in 
Hispanic families and communities, 3) the 
relationship of characteristics and dynamics 
of Hispanic communities in primary prevention 
and intervention in individuals and families 
in crisis, 4) the relationship of migration to 
psychological adjustment, 5) the relationship 
of education to psychological adjustment, and 
6) the psychodynamics and sociocultural fac- 
tors of females who are heads of households. 
Three major conclusions regarding alcohol, 
drug abuse, and mental health services were 
drawn. First, primary prevention and inter- 
vention must reflect the culture and lifestyle 
of the people proposed to be served. Second, 
new models in alcohol, drug abuse, and mental 
health research need to be developed. Third, 
recognition must be given to the fact that the 
United States is rapidly becoming a multiple 
options society. Therefore, more emphasis must 
be given to bicultural/multicultural processes 
among minority ethnic groups and less on the 
ideas of acculturation and assimilation. Fu- 
ture research suggested by the reviewer in- 
cluded the areas of coping with rapid change, 
the effects of migration on psychological 
adjustment, identification of support net- 
works, among youth, drug and alcohol abuse, 
the development of Mestizo world view theore- 
tical approaches, instruments for data collec- 
tion, and research methodologies. 22 Refer- 
ences. 



162 



Author : 



Title: 



Source: 
Abstract: 



Rassin, D. K. , Richardson, C. J, 



Baranowski, 



T., Nader, P. R. Guenther, N. , Bee, D. E. , & 
Brown, J. P. (1984) . 

Incidence of breast-feeding in a low socio- 
economic group of mothers in the United 
States: Ethnic patterns. 
Pediatrics , 73(2), 132-137. 
The purpose of this study was to identify 



167 



factors which are associated with the decision 
to breast-feed or not in a population of 379 
mothers. Three hundred and fifty-eight 
(94.5%) self -completed questionnaires were 
obtained. The data included demographic infor- 
mation, reproductive history, prenatal care 
and education. Only 27.2% of the sample chose 
to breast-feed. Using a chi square test for 
equality of proportions, marital status, head 
of household, maternal and paternal ethnicity, 
maternal education, income, and number of 
pregnancy were found to be the most important 
variables associated with breast-feeding. The 
effect of ethnicity was more significant than 
other demographic variables when examined 
jointly within ethnic groups. The percentage 
of Mexican American mothers who intended to 
breast-feed was 18.4% or 62 mothers while 14 5 
Anglo Americans (42.9%) and 131 Black Ameri- 
cans (38.7%) chose to breast-feed. It was 
concluded that the importance of ethnicity in 
the decision to breast-feed has been underes- 
timated. Therefore, attempts to encourage 
breast-feeding ought to take this factor into 
account. 10 References. 



163. Author: Redman, J. E., & Mora, D. B. (1982). 

Title: Malignant melanomas of the skin diagnosed and 
treated in Albuquerque, New Mexico, in 1980. 

Source: The Journal of Dermatologic Surgery and 
Oncology , 8(1), 40-43. 

Abstract: Fifty eight cases of malignant melanomas 
treated in Albuguerque, New Mexico were anal- 
yzed. The information was made available 
from the tumor registers for 1980 of Albu- 
querque's eight hospitals, three laboratories 
of pathology, two dermatologists and by the 
New Mexico Tumor Registry. Findings indicate 
that the majority (91%) of the reported cases 
of malignant melanoma were in White, fair- 
skinned patients. Only 5% of the cases were 
of American Indian and 3% of Hispanic ances- 
try. The two Hispanic cases were both females 
ages 52 and 42 years. The anatomic location 
of their malignant melanoma was the trunk for 
both cases with an unspecified level of 
thickness. The authors indicate that the 
number of cases of malignant melanomas among 
the general population treated in Albuquerque 
in 1980 have increased by more than 300% since 
data began to be kept in 1971. 2 References. 



168 



164. Author: 

Title: 
Source: 

Abstract: 



Reed, B. D. , Lutz, L. J., Zazove, P., & Rat- 
cliffe, S. D. (1984). 

Compliance with acute otitis media treatment. 
The Journal of Family Practice , 19 (5) , 627- 
632. 

The purpose of this study was to determine 
whether the type of medical office, population 
served, written instructions to the patient, 
or patient familiarity with the prescribing 
physician influenced the patient to continue a 
10-day course of antibiotics prescribed for 
acute otitis media. Four offices and a total 
of 295 patients were examined and the rela- 
tionship between the recommended treatment as 
followed by the patient and the outcome were 
determined. Four different types of family 
practice centers were used, and study popula- 
tion were all patients with a newly diagnosed 
case of acute otitis media. Compliance was 
measured by follow-up rates in less than 11 
days and urine antibiotic assays, varied sig- 
nificantly between different patient popula- 
tions and office types. Results reported that 
written instructions did not improve compli- 
ance. When patients were diagnosed and 
treated by their own physicians, compliance 
was improved in the low socioeconomic sector. 
Study factors and compliance were not related 
to outcome. (Author's abstract modified). 



165, 



Author : 
Title: 



Source: 
Abstract: 



Reid, S. (1984) . 

Cultural difference and child abuse inter- 
vention with undocumented Spanish-speaking 
families in Los Angeles. 
Child Abuse and Neglect , 8, 109-112. 
This essay seeks to identify economic factors 
and cultural differences among undocumented 
Spanish-speaking families in Los Angeles, 
which may result in misinterpretation of child 
abuse by social workers. Social workers need 
to understand the strong cultural values of 
the undocumented and how these contrast with 
those of the surrounding society in order to 
make determinations that are truly in the best 
interest of children. The study reviews eco- 
nomic factors and family values involved in 
the three kinds of reports of abuse most fre- 
quently received concerning such families: 1) 
reports of children living in inadequate hous- 
ing without proper food or clothing: 2) 
reports of children left alone in the care of 
a child under 13 years of age; and 3) reports 
of bruises with no abrasions or serious injur- 



169 



ies, inflicted by the parents as punishment. 
Many of these "abusive" conditions arise from 
the stress attributable to the substandard 
living conditions of the undocumented and from 
cultural conflicts they experience. It is 
essential for a social worker to distinguish 
between parental neglect and poverty and be- 
tween discipline and child abuse when working 
with undocumented Spanish-speaking families. 
References. 



166. Author: Rios, L. E. (1982) . 

Title: Determinants of asthma among Puerto Ricans. 
Source: The Journal of Latin Community Health , 

1(1) ,25-40. 
Abstract: Several epidemiological studies have suggested 
a higher prevalence of asthma among Puerto 
Ricans as compared to Afro-Americans or non- 
Hispanic Caucasians. This article reviews the 
literature in two areas: 1) epidemiology of 
asthma among Puerto Ricans; and 2) known gene- 
tic and enviromental determinants of asthma as 
they relate specifically to Puerto Ricans. 
This article proposes that if Puerto Ricans 
exhibit greater intrinsic asthma than the 
general population, this may explain three 
disparate sets of findings about Puerto Ri- 
cans. These findings are: asthma among adults 

there is a 
of asthma pa- 
seen by emer- 
more 



increases in severity with age, 
higher female to male ratio 
tients, and Puerto Ricans are 
gency wards due to asthma 



attacks 



freguently then are members of other ethnic 
groups. Furthermore, genetic studies to date 
have not found a hereditary basis for higher 
prevalance and/or severity of asthma among 
Puerto Ricans. Similarly, increased sensiti- 
vity to a specific antigen has not been demon- 
strated, nor have parasitic infestation been 
implicated. Lastly, clinical and public 
health applications of relevant findings are 
briefly dicussed and areas for further 
investigation are suggested. 47 References. 



167. Author: Rojas, D. (1980). 

Title: Effect of maternal expectations and child- 
rearing practices on the development of White 
and Puerto Rican Children. 

Source: Maternal and Child Nursing Journal , Summer , 
99-107. 

Abstract: This study was designed to help define devel- 
opment in the Puerto Rican mainland child and 



170 



describe the maternity role of the social- 
ization process within the Puerto Rican 
culture. The objectives of the study were to 
compare 1) the development status of White and 
Puerto Rican children 1-3 years of age, 2) the 
child-rearing methods and expectations of 
White and Puerto Rican mothers within a lower 
socioeconomice status, 3) the maternal child- 
rearing methods and expectations toward male 
and female children in both White and Puerto 
Rican groups. Eleven White and eleven Puerto 
Rican well children were chosen from pediatric 
services at a university medical center and in 
a neighborhood health center with specific 
criteria for selection. The Denver Develop- 
mental Screening Test ( Frankenburg and Dobbs, 
1967) , was used to measure development. The 
Child-Rearing Practices Report (Block 1965) 
measured child-rearing techniques and orienta- 
tion. The Maternal Expectations Report 
designed by the author measured the age at 
which a mother expects her child to perform 
various developmental milestones. No signifi- 
cant differences were found between the White 
and Puerto Rican children 1-3 years. A 
notable difference was found in language de- 
velopment between the two groups. The eleven 
White children passed 73.5% of the age-approp- 
riate items at 50 percentile while the eleven 
Puerto Rican children passed 53.3.% of the 
respect to child-rearing practices, Puerto 
Ricans mothers were more protective than White 
mothers and had a more positive relationship 
with their children. Puerto Rican mothers 
used average control and physical punishment 
more often than the White mothers. Threat of 
future punishment was more often used by 
Puerto Rican mothers along with use of guilt 
and strict and arbitrary rule setting. The 
author concluded that in order to protect 
their children from the world, Puerto Rican 
mothers set strict rules and enforce them with 
aversive control and physical punishment. This 
in turn may inhibit outside exploration with 
response to only commands and rules. In addi- 
tion, since the Puerto Rican families are low 
socioeconomic status, they may have an envi- 
ronment which lacks appropriate verbal stimu- 
lation. This, in combination with strict 
mothers, may have influenced the slower rate 
of language development. 14 References. 

168. Author: Saunders, P. H. , Banowsky, L. H. , & Reichert, 



171 



Title: 



Source: 
Abstract: 



D. F. (1984) . 

Survival of cadaveric renal allografts in 
Hispanic as compared with Caucasian reci- 
pients. 

Transplantation, 37 (4) , 359-362. 
Allograft survival rates were evaluated and 
showed a significantly better graft survival 
in Hispanic (n=66) compared to Caucasian 
(n=38) recipients of primary cadaveric renal 
transplants. In terms of patient survival 
pretransplant transfusion status, there were 
no significant differencees between Hispanic 
and Caucasian cadaveric recipient groups. 
Ethnic origin of cadaveric donor did not sig- 
nificantly alter graft survival rates in 
either recipient ethnic groups, nor were they 
signif icatnly altered by immunosuppresive pro- 
tocals. rejection therapy, mean age, or 
frequency of diabetes mellitus. Caucasian 
patients with splenectomies had better 
cadaveric graft survival than Caucasian graft 
recipients without splenectomies. However, 
splenectomy had no significant effect on the 
renal allograft survival rate in Hispanics. 
Donor recipient HLA matching (A, B, or DR) , 
and panel reactivities of recipient pregraft 
serum samples were evaluated and found not to 
correlate significantly with cadaveric graft 
survival rates. Although Hispanic cadaveric 
renal allograft survival were superior to 
Caucasian recipients, 1-haplotype-matched or 
2-haplotype matched living-related renal allo- 
grafts had comparable graft survival rates in 
both Caucasian and Hispanic recipients. Find- 
ings indicate that Hispanics without 
splenectomy enjoy a cadaveric renal allograft 
survival rate superior to nonsegregated popu- 
lations as reported in other studies. (Author 's 
abstract modified.) 



169. Author: Selby, M. L. , Lee, E. S., Tuttle, D. M. , & 

Loe, H. D. (1984) . 

Title: Validity of Spanish surnamed infant mortality 
rate as a health status indicator for Mexican 
American population. 

Source: American Journal of Public Health , 7_4(9) , 998- 
1002. 

Abstract: The purpose of this study was to assess the 
validity of the Spanish surname infant mortal- 
ity rate as an index of the health status for 
the Mexican American population in an urban, 
non-border, setting considered to have an 
excellent birth and death registration system. 



172 



The study population was composed of all 
68,584 single live births of Spanish surname 
White, non-Spanish surname White, or Black 
ethnicity. Neonatal and post neonatal mor- 
tality rates were examined according to vari- 
ables available from the birth certificates: 
birth weight, birth order, maternal age, time 
of first prenatal care, ethnicity, and paren- 
tal nativity. It was hypothesized that if 
calculated Spanish-surname infant mortality 
rates were valid, the rates of foreign-born 
Spanish-surname parental nativity subgroup 
would be higher than the rates for the U.S. 
born parental nativity subgroup. If the rates 
were found to be higher, the migration of the 
foreign-born group should be considered as a 
confounding factor. It was found that infants 
born to Mexican immigrants had low mortality 
rates for high birth order, high maternal age, 
and delayed or absent prenatal care. Only 
infants who weighed less than 1500 grams 
exhibited the expected high rates. The 
findings suggested a loss of infant death 
compatible with migration and under registra- 
tion of deaths. It was concluded by the 
authors that the Spanish surname infant mor- 
tality may be low and does not seem to be a 
valid indicator of Mexican American health 
status even in an urban, non-border area 
considered to have an excellent registration 
of births and deaths. 16 References. 



170. Author: Shanley, J. D. & Jordan, M. C. (1980) . 

Title: Clinical aspects of CNS cysticercosis. 

Source: Archives of Internal Medicine , 140 (10) , 1309- 
1313. 

Abstract: Central nervous system cysticercosis (CNS) , an 
infection with the larva of the pork tapeworm 
(Taenia solium) , is common throughout the 
world. Ingestion of fecal contaminants con- 
taining the ova of T solium causes the 
infection. Number, age, and location of the 
larval cysts disrupting the neural tissues 
vary the clinical manifestations. Five disease 
patterns are given: 1) basilar cysticercosis 
resulting from chronic meningitis or progres- 
sive hydrocephalus, 2) parenchmal cysts with 
focal symptoms, 3) diffuse parenchymal cysts 
with intracranial hypertension, 4) ventricular 
localization with episodic acute hydroceph- 
alus, and 5) spinal cord cysticercosis which 
appears like mass lesions. The basic pattern 
may occur in a mixture and asymptomatic infec- 



173 



tions are common. Menigitis cysticercosis is 
often mistaken for tuberculous or fungal 
meningitis in the United States. For a patient 
with these syndromes who has lived in an area 
of high prevalence of T. sodium, the diagnosis 
of CNS cysticercosis should be considered. 
(Author's abstract modified) 



171. Author: Smith, K. J., Coonca, L. S., South, S. F., & 

Troup, G. M. (1983) . 

Title: Anti-Cra: Family study and survival of 
chromium-labeled incompatible red cells in a 
Spanish-American patient. 

Source: Transfusion , 23_(2) , 167-169. 

Abstract: After transfusion during colectomy, a 22-year 
old Hispanic women with juvenile rheumatoid 
arthritis developed anti-Cra. Among 13 rela- 
tives no Cra negative family members were 
found, including siblings and parents. Chro- 
mium-labeled red cells survival studies showed 
a Tl/2 of 14 days with Cra positive cells. 
After ileorectal anastomosis, two units of Cra 
positive blood were transfused uneventfully. 
(Author's abstract modified) . 



172. Author: Spector, M. H. , Applegate, W. B. , Olmstead, S. 

J., DiVasto, P. V. , & Skipper, B. (1981). 

Title: Assessment of attitudes toward mass screening 
for colorectal cancer and polyps. 

Source: Preventive Medicine , 10 , 105-109. 

Abstract: A study attempting to reveal the reasons for 
poor volunteer response to colorectal cancer 
screening. A questionnaire was distributed to 
202 patients at the University of New Mexico 
outpatient clinic. Of the 154 who completed 
the questionnaire, only 70 volunteered for 
screening. Those who completed the question- 
naire were all over 40. Forty-seven were men 
and 107 were women. Seventy-four were Anglos, 
67 Hispanic, and 13 were other. The question- 
naire was geared toward determining whether 
differences in attitude toward health care 
providers, aspects of the screening process, 
and perceived vulnerability to cancer would 
discriminate between volunteers and non-volun- 
teers. Hispanics were less likely to volunteer 
than Anglos. Non-volunteers were more likely 
to deny the possibility of having cancer and 
to object to particular aspects of the screen- 
ing process. 4 References. 

I.D.No.: 13G 



174 



173 



Author : 
Title: 

Source: 



Abstract; 



Staff. (1983). 

Lead poisoning from Mexican folk remedies — 
California. 

U.S. Department of Health and Human Services , 
Public Health Service , Center for Disease 
Control , Morbidity and Mortality Weekly 
Report , 32(42), 554-555. 

As a result of the death of a 3 -year old in 
June 1982 who had been unsuccessfully treated 
for diarrhea and the illness of his 15-month- 
old sibling, the Los Angeles County Department 
of Health and Human Services surveyed resi- 
dents of six predominantly Hispanic geograph- 
ically representative census tracts in an 
attempt to estimate use and knowledge of 
azarcon (lead chloroxide) and greta (lead 
oxide) . A total of 545 systematically select- 
ed households, predominately Hispanic, were 
selected. Familiarity with the substance was 
greatest among Mexican Hispanics, and prior 
use was exclusive to this group (7.2-12%) 
admitted prior use) . A Colorado survey in 
June-September, 1982, among Texas farmworkers 
showed that 7% of 100 migrant children under 
12 years of age had been treated at some time 
with greta or azarcon for gastrointestional 
illness. Since the summer of 1981, when the 
first cases of azarcon poisoning were 
identified in California and Colorado, there 
have been multiple cases and there is an indi- 
cation that a significant exposure to both 
azarcon and greta by infants and children with 
abdominal distress has developed. Major media 
effects publishing the danger of the two che- 
micals have been directed to the Hispanic com- 
munities in California. The U.S. Food and Drug 
Administration has instituted a national re- 
call of greta and is investigating its use in 
other states. Mexican health authorities have 
reportedly instituted recall efforts in Mexico. 
Health professionals are urged to report cases 
of lead poisoning and to promote educational 
programs in their Hispanic communities regard- 
ing the dangers of these folk remedies. 
References. 



174 



Author : 

Title: 

Source: 



Abstract: 



Staff. (1984). 

Measles Outbreak — New York City. 

U.S. Department of Health and Human Services, 

Public Health Service Morbidity and Mortality 

Weekly Report , 33(41), 580-586. 

This article reports on the outbreak of 

measles in East Harlem reported by the New 



175 



York Department of Health from February 8 to 
May 23, 1984. Thirty-four cases, including 18 
females were identified. Thirty-one cases 
(91%) were of Hispanic origin. While measles 
were simultaneously discovered in two areas of 
East Harlem, a common source of infection was 
not identified. To control the spread of 
measles, especially among pre-schoolers, vac- 
cination clinic hours were increased from 3 to 
24 hours of clinic time and measles vaccina- 
tion was recommended for children 6 months to 

11 months in the outbreak area. Subsequent 
reimmunization with measles, mumps and 
rubella (MMR) vaccine at fifteen months 
was recommended for all children vaccinated 
before their first birthday. Harlem children 

12 months or older were vaccinated with a com- 
bined MMR vaccine. References. 



175. 



Author : 
Title: 

Source: 



Abstract: 



Staff. (1982). 

Tuberculosis among Hispanics in the United 
States-1980. 

U.S. Department of Health and Human Services 
Public Health Service , Morbidity and Mortality 
Weekly Report , 31(18) . 

This is a report of Hispanic tuberculosis case 
rates in the United States during 1980. The 
report indicates that among Hispanics age 35 
and younger, the age specific incidence of 
tuberculosis was from 2.7 to 4.2 times greater 
than for other ethnic/racial groups. In the 
five Southwestern states, Hispanics comprised 
slightly more than 25% of all reported cases. 
The tuberculosis case rate was higher for 
Hispanics living in the cities with popula- 
lations of 250,000 or more, than for Hispanics 
living in less populated areas. The report 
concludes that Hispanics currently at signif- 
icantly higher risk of having tuberculosis 
than most other persons in the United States 
and are likely to remain so for at least 
several decades. 2 References. 



176. Author: 

Title: 

Source: 
Abstract : 



Stern, M. P., Gaskill, S. P. Allen, Jr. C. R. , 
Garza, V., Gonzales, J. L. & Waldrop, R. H. 
(1981) . 

Cardiovascular risk factors in Mexican Ameri- 
cans in Laredo, Texas. II. Prevalence and 
control of hypertension. 

The American Journal of Epidemiology , 113 (5) , 
556-562. 
The level of hypertension control in both 



176 



Blacks and Whites have improved greatly in 
recent years. This information is still not 
available on Mexican Americans. A random 
sample of Mexican Americans from two low- 
income census tracts in Laredo, Texas, were 
surveyed. The percentages of hypertensive 
women who had been previously diagnosed, were 
under treatment, and were under control com- 
pared favorably with national figures for 
Blacks and Whites. However, the data indicated 
that men still lagged behind the national 
figures for levels of diagnosis, treatment and 
control. In the Laredo Project, the prevalence 
of hypertension was midway between those shown 
in national studies for Blacks and Whites. 
When findings were based on blood pressure 
distributions or elevated diastolic pressures, 
the results were not as clear. The number of 
"controlled" hypertensives in the population, 
comparisons between populations and across 
time can no longer be based exclusively on 
blood pressure measurements, but must include 
cases of controlled hypertension. (Author's 
abstract modified) . 



177 



Author : 
Title: 

Source: 

Abstract: 



Stern, M. P. (1984, December) . 
Factors relating to the increased 



prevalence 



of diabetes in Hispanic Americans . 
Paper presented to the Task Force on Black and 
Minority Health, Bethesda, MD. 

Recent epidemiological health studies reveal a 
trend whereby Mexican Americans seem to be at 
a higher risk for developing diabetes. It 
remains unclear as to whether other Hispanic 
subgroups experience similarly high prevalence 
rates. This article reviews recent diabetes 
prevalence studies conducted with both Mexican 
American and other Hispanic subgroups with a 
focus on methodological considerations. For 
example, few studies are consistent in their 
definition of diabetes which often results in 
over- or under-estimates of the disorder. The 
authors summarize factors which seem to con- 
tribute to the higher prevalence of diabetes 
among Mexican Americans emphasizing the marked 
effects of socioeconomic status and accultura- 
tion. The authors conclude by providing 
policy implications for prevention programs 
which are tailored to the cultural orientation 
of the Mexican American population. Also 
recommended is future research which clarifies 
the relationship between cultural orientation 
and health habits and attitudes, which can 



177 



then assist in the design of culturally accep- 
table educational materials. 23 References. 



178. Author: 

Title: 
Source : 
Abstract: 



Sujansky, R. , Smith, A. C. M. , Peakman, D. C, 
McConnell, T. S., Baca, P., & Robinson, A. 
(1981) . 

Familial pericentric inversion of chromosome 
8. 

American Journal of Medical Genetics , 10 , 229- 
235. 

The purpose of this paper is to discuss seven 
families of Mexican American ancestry with 
infants presenting similar congenital anom- 
alies and an unbalanced recombinant chromosome 
8. Parental chromosomes underwent analysis. 
It was found that one member of each couple 
was found to carry a pericentric inversion of 
chromosome 8. The propositi had an unbalanced 
recombinant chromosome. The infants who were 
affected were developmentally delayed, with 
congenital heart disease, and an unusual ap- 
pearance. The findings indicated a common 
origin of pericentric inversion. This was 
suggested because of geographic location and 
the Mexican American ancestry of the seven 
families. 9 References. 



179. Author: Sunseri, A. J., Alberti, J. M. , Kent, N. D. , 

Schoenberger, J. A., & Dolecek, T. A. (1984). 

Title: Ingredients in nutrition education: Family 
involvement, reading and race. 

Source: Journal of School Health , 54(5), 193-196. 

Abstract: An evaluation of a health education program 
designed for sixth-graders and their families. 
A pre-test and post-test was administered to 
213 students, including 78 Black, 34 Hispanic, 
and 89 White students. The results indicate 
that it was possible to conduct a family 
intervention with an educationally and racial- 
ly diverse urban population. The patterns of 
family involvement and student outcomes varied 
for the different groups. Reading was signi- 
ficantly related to nutrition knowledge and 
attitude but not to behavior. Reinforcements 
appear to be necessary for students to main- 
tain changes over time. 16 References. 



180. Author: 
Title: 

Source: 



Tebben, M. P. (Ed.) (1982). 

HHS demonstration project for hypertension 
control focus on Blacks and Hispanics. 
Public Health Reports , January/February , 84. 



178 



Abstract: An award had been made for the establishment 
of demonstration projects for hypertension 
control to provide five sites serving predomi- 
nately Black and Hispanic populations. This 
implements recommendations of the Black Health 
Providers Task Force on Hypertension Education 
and Control. Two sites will serve urban 
Blacks, two will serve rural Blacks, and one 
will serve a rural Hispanic population. Mate- 
rials based on the experiences at the site 
will be developed for national use, as well as 
treatment techniques. References. 



181. Author: Teberg, A. J., Howell, V. V., & Wingert, W. A. 

(1983) . 

Title: Attachment interaction behavior between young 
teenager mothers and their infants. 

Source: Journal of Adolescent Health Care , 4_(1) , 61- 
66. 

Abstract: This paper reports on behavioral interaction 
between teenage mothers and their infants. 
Study population was 26 Hispanic, low SES 
teenage mothers with a mean age of 15 years 
and their infants with a mean age of 13.5 
months. The control group of thirty mothers 
had a mean age of 26 years and their infants 
mean age was 14.0 months. Only 26% of the 
control infants showed a limited ability to 
handle stress compared to 47% of the infants 
of teenage mothers. More effective eye, ver- 
bal, physical contact, and smiling behavior 
was exhibited by the control mothers. The 
authors suggest that limited teenage maternal 
behaviors may have a negative psychologic 
effect for both the infants and the mothers. 
Abstract. 



182. Author: Tejani, A., Nicastri, A. D. , Chen, C-K. , 

Eikrig, S., & Gurumurthy, K. , (1983). 

Title: Lupus nephritis in Black and Hispanic 
children. 

Source: American Journal of Diseases of Children , 
137(5), 481-483). 

Abstract: A sample of 23 children (17 Black and 6 Hispa- 
nics of unspecified national origin) was stu- 
died at the Pediatric Renal Immunology and 
Hematology Division of the SUNY Hospital in 
Brooklyn, New York. Records were reviewed for 
children seen between 1972 and 1981 with a 
diagnosis of systemic lupus erythematosus 
(SLE) . The mean follow-up period was 5.4 
years. The mean age at onset was 10.1 years, 



179 



which is younger than is usually described. 
There was a higher rate of death in those 
whose diseases started before age 10. Twenty- 
five percent of the patients died of renal 
causes, and another 25% have been undergoing 
dialysis, receiving transplants, or were in 
chronic renal failure. The mortality in the 
sample was higher than in other children sug- 
gesting that age and race may be interacting 
to produce higher morbidity and mortality. 21 
References. 



183 



Author : 



Title: 

Source: 
Abstract: 



The Texas Migrant Council, National Resource 
Center on Child Abuse and Neglect for Mexican 
American Migrants & Berrios, L. (1981) . 
Child abuse and neglect among Mexican American 
migrants : A study of cases . 

Laredo, Texas: The Texas Migrant Council Inc. 
An analysis of 193 cases of child abuse in a 
population of Mexican American migrant 
workers. Data were provided on the etiology 
of child abuse and neglect. Attention is paid 
to demographic variables, definite situations 
and specific behaviors. A brief assessment of 
services offered to the clients is provided. 
The major conclusions are that: social envi- 
ronments, coupled with parental inability to 
cope with stressful situations, lead to child 
abuse and neglect; transiency accentuates the 
incidence and prevalence of child abuse and 
neglect; Mexican American culture, by emphasi- 
zing family cohesions and support, ameliorates 
the disruptive impact of social environmental 
stress. 10 References. 



184 



Author : 
Title: 



Source: 



Abstract: 



Torres, A. M. (Ed.). (1982). 

The prevention and treatment of child abuse 
and neglect: A focus on the Mexican American 
family. 

Proceedings of the Second Annual Conference , 
Texas Migrant Council National Resource Center 
on Child Abuse and Neglect for Mexican Ameri- 
cans . San Antonio, Texas: Texas Migrant 
Council, Inc. 

The second Annual Conference on the Prevention 
and Treatment of Child Abuse and Neglect, "a 
focus on the Mexican American Family" spon- 
sored by the Texas Migrant Council's National 
Resource Center on Child Abuse and Neglect of 
Mexican Americans in cooperation with AVANCE 
Parent-Child Education Program was held in San 
Antonio, Texas. Four hundred participants 



180 



interacted with top Mexican American and non- 
minority specialists in the field of child 
abuse and neglect. Goals of the conference 
were to increase participation of Mexican 
Americans and non-minority specialists in the 
field of child abuse and neglect, to increase 
participation of Mexican American profes- 
sionals in child abuse and neglect issues and 
to increase the awareness of workers, adminis- 
trators, and others of the cultural dynamics 
involved when working with Mexican American 
families. Twenty-six papers were presented. 
These were divided into five issues: 1) socio- 
cultural perspectives in the prevention and 
treatment of child abuse and neglect among 
Mexican Americans, 2) research efforts in 
child abuse and neglect in the Mexican Ameri- 
can community, 3) culturally relevant inter- 
vention approaches with Mexican American fami- 
lies, 4) innovative prevention and treatment 
programs and delivery systems, and 5) special 
topics in child abuse and neglect. Judge 
Enrique H. PeTSa in the foreward stresses that 
findings of the conference will serve to dis- 
pel the myths about Mexican American families 
and avoid stereotyping. They will challenge 
the system of prevention, investigation and 
treatment of cases involving child abuse and 
neglect to look at such cases from the per- 
spective of the Mexican American family. 187 
References. 



185. Author: Trevthan, W. R. (1981). 

Title: Maternal touch at 1st contact with the newborn 
infant. 

Source: Developmental Psychobiology , IK 6 ) / 549-559. 

Abstract: This study investigates a report that mothers 
exhibit a species-characteristic pattern of 
touching new-born infant extremities with 
their fingertips and then progressing to mas- 
saging of the infant's trunk. Data on mater- 
nal tactile interaction during 10 minutes of 
contact following delivery was collected from 
a study population of 66 mothers and new-born 
infants. Most of these were of Hispanic ori- 
gin and delivery had been by midwives in a 
Texas maternity center. Tactile behavior was 
recorded every ten seconds, using time- 
sampling techniques, with most observations 
beginning in the first ten minutes after 
birth. Findings were that maternal tactile 
behavior in the first ten minutes of active 
interaction was more variable than had pre- 



181 



viously been reported. There was no evidence 
of a touch progession: the tactile exploration 
seemed to vary with the sex of the infant, as 
well as socioeconomic or sociocultural back- 
ground of the mother. (Journal abstract 
modified) . 189 References. 



186, 



Author : 
Title: 

Source: 



Abstract; 



Trowbridge, F. L. (1982) . 

Prevalence of growth stunting and obesity: 
Pediatric Nutrition Surveillance System. 
U.S. Department of Health and Human Service . 
Public Health Service , Morbidity and Mortality 
Weekly Report , Surveillance Summary , .32 (4) , 
2355-2655. 

This paper reports on data from the 1982 pedi- 
atric surveillance summary related to growth 
stunting and obesity, which has been observed 
in from 6 to 16% of children between the ages 
of birth through 4 years. Findings show stunt- 
ing trends increase with age, with Native 
American and Hispanic children having the 
highest increase. In different age and ethnic 
groups, obesity was found to vary from 5% to 
13%. Although obesity increases in infants of 
one year compared to those of less than one 
year, there is no consistent trend from 2 to 4 
years of age. Highest prevalence of obesity 
is found in Native American Children, followed 
by Hispanic children, when obesity is measured 
by weight for height. It was suggested that 
thinness is not a significant public health 
problem in the study population. Issues of 
interpretation are raised and it is suggested 
that whereas the diet of these children may be 
adequate in quantity, it does not have the 
necessary nutritional quality. References. 



187. Author: Tunder, J. (1984, November). 

Title: Women's cancer screening and prevention pro- 
ject final report. 

Source: (Available from Venice Family Clinic, 604 Rose 
Avenue, Venice, CA. 90291) . 

Abstract: A final report of the second year of an Ameri- 
can Cancer Society-sponsored cancer screening 
clinic aimed at low income, primarily Hispanic 
women. The major innovation was the develop- 
ment and implementation of a Spanish-language 
cancer discussion group, piloted as a means of 
reducing the cultural and other barriers that 
keep such women from utilizing screening and 
prevention programs. Information about breast 
self-examination, Pap test, and pelvic examin- 



182 



ation was provided, with measurable increases 
in knowledge recorded. 572 patient visits 
were achieved. All the patients were low 
income, 76% were Hispanics, 74% were mono- 
lingual in Spanish, and 56% were 35 years of 
age or older. The project also provided pla- 
cement for health care professional training. 
The report also contains appendices of origi- 
nal material, including: Intake Question- 
naire, Breast Self -Examination Assessment 
Sheet, Health Professionals' Training Evalua- 
tion Questionnaire, Women's Clinic Protocols, 
and Venice Family Clinic Patient Statistics. 
References. 



188. Author: 
Title: 

Source: 

Abstract: 



Vieira-Caetano, R. J. (1983) . 

Drinking patterns and alcohol problems among 
Hispanics in Northern California . 
Ann Arbot, MI: University Microfilms Interna- 
tional. No. 8328811. 

The data from this dissertation came from 
three independent general population surveys 
carried out in 1977, 1978, and 1980 in three 
communities in Northern California. The pur- 
pose of the study was to explore the alcohol 
comsumption problems among Hispanics. More 
specifically, to analyze frequency and quality 
of drinking patterns, levels and type of alco- 
hol related problems and attitudes and knowl- 
edge of alcohol effects. The total number of 
respondents were 634 Hispanic males and fe- 
males between the ages of 18 and 59 most of 
whom were married, employed and Catholic. The 
findings indicated that among Hispanic males, 
alcohol is consumed in large amounts by young, 
single, separated, or divorced and Catholic. 
Among Hispanic females, drinking is associated 
with being young, single, separated or div- 
orced and having a higher income and educa- 
tion. Drinking patterns among Hispanic males 
are more uniform than among Hispanic females. 
Hispanic males get drunk more often and have 
more alcohol-related problems than men in the 
general population. As for Hispanic females, 
they drink less, have fewer problems and hold 
less permissive attitudes toward drinking than 
Hispanic males. 276 References. 



189. Author: 
Title: 

Source: 



Wittenberg, C. K. (1983). 
Summary of market research for 
Mothers, Healthy Babies" campaign. 
Public Health Reports , 98(4), 356-359. 



"Healthy 



183 



Abstract: Reports of focused group sessions held with 
seven groups of Mexican American women and 
eight groups of Black women. There is no 
numerical data, but insights are offered. 
Conclusions include the following: in educa- 
tional campaigns, the link between the 
mother's behavior and the baby's health must 
be made clear; the questions that interest 
the pregnant woman should first be answered 
before moving on to other topics that need 
emphasis; individual counseling should be used 
to teach pregnant women; a multi-media ap- 
proach is needed to reach women of lower so- 
cioeconomic status; the WIC program could 
serve as a model of how to reach women of 
lower socioeconomic status. 3 References. 



190. Author: Young, J. L. (1981). 

Title: Cancer and the Hispanic elderly. 

Source: In P. Vivo & C. S. Votow (Eds.), The Hispanic 
Elderly : La Fuente de Nuestra Historia , 
Cultura, y Carifio (pp. 1106-1112) . Rockville, 
MD. : Department of Health and Human Services, 
Public Health Service (Spanish Heritage Public 
Health Service Workers) . 

Abstract: The Surveillance, Epidemiology and Results 
(SEER) program initiated by the Cancer Insti- 
tute collected cancer related data from 1973 
to 1977 in ten areas of the United States 
including Puerto Rico; 5% of the elderly 
(over 65) Hispanic population in the areas of 
Puerto Rico, San Francisco/Oakland and New 
Mexico were covered. Criteria for identifying 
Hispanics was Spanish surname of patient and/ 
or residence in Puerto Rico. The data re- 
vealed that the Hispanic elderly are at lower 
risk for cancer than Whites or Blacks and 
about the same risk as Orientals and American 
Indians. The 10 most common cancers found 
among elderly Hispanic males were cancer of 
the prostate, lung, stomach, colon-rectum, 
pancreas, lymphomas, bladder, leukemias, 
kidney and brain, in descending order. Among 
elderly Hispanic females the 10 most common 
cancers were cancer of the breast, cervix, 
lung, stomach, pancreas, ovary, corpus, gall- 
bladder and lymphomas, also in descending 
order. Hispanic elderly face relatively lower 
lung cancer risks than Whites, but are at a 
higher risk than Whites for cancer of the 
pancreas and stomach. Different risk patterns 
were observed in Puerto Rico, New Mexico and 
San Francisco. New Mexico/San Francisco had a 



184 



higher risk of pancreatic cancer and Puerto 
Rico had an increased risk of esophageal 
cancer. The overall relative cancer risks of 
elderly Hispanics when compared to Whites for 
all cancers was 65% for males and 89% for 
females. References. 



191. 



Author : 
Title: 



Source: 
Abstract: 



Zeltzer, L. K. , & Lebaron, S. (1985). 
Does ethnicity constitute a risk factor in the 
psychological distress of adolescents with 
cancer? 

Journal of Adolescent Health Care , 6, 8-11. 
To determine if ethnicity constitues a risk 
factor in the psychological distress of ado- 
lescents with cancer, ethnic comparison (His- 
panic versus Anglos) were made on four psycho- 
logical measures (trait anxiety, selfOesteem, 
locus of control, impact of illness) adminis- 
tered to 54 adolescents with cancer. Data 
from the largely Mexican American San Antonio 
sample were then compared to test scores from 
a largely Anglo Los Angeles sample. The im- 
pact of cancer did not differ among Mexican 
American and Anglo adolescents. Both groups 
experienced normal anxiety traits and self- 
esteem; however, both groups perceived little 
control over their health. A San Antonio 
subsample of 25 adolescents with cancer who 
received behavioral intervention for relief of 
treatment-related distress were retested on 
these psychological measures at six months 
following intervention and test score changes 
were compared to those found in a similar Los 
Angeles study. Adolescents from both ethnic 
groups demonstrated similar reductions in 
their trait anxiety scores following behav- 
ioral intervention. Authors concluded that 
ethnicity per se does not appear to have a 
major influence on the experience of cancer in 
adolescents. Nevertheless, their findings sug- 
gest that membership in a minority group and a 
clinic's attitude toward ethnic differences 
may play an important role in acceptance or 
rejection of behavioral intervention and thus 
merit investigation. 17 References. 



192. Author: Zepeda, M. (1982). 

Title: Selected maternal-infant care practices of 
Spanish-speaking women. 

Source: Journal of Obstetric , Gynecologic , and Neo- 
natal Nursing , 11(6), 371-374. 

Abstract: This is a report of an informal 



study of 30 



185 



Hispanic women to discover which postpartum 
maternal-infant care practices were common in 
a Southern California Hospital. The popula- 
tion was surveyed first in the hospital, and 
then in the patient's home, where seven open- 
ended questions were related to umbilical cord 
care and isolation practices. Findings were 
that Hispanic women follow cultural patterns. 
Other implications of nursing practices for 
use with Hispanic women were discussed. 
(Journal Abstract Modified) . 



186 



Reports in the 
Popular Press 



187 



193. Author: Associated Press Staff. (1985, February 24). 

Title: Heart disease tied to poverty. 

Source: New York Times , p. 24L. 

Abstract: A report of a study which concluded that heart 
disease is more likely to kill the poor than 
the affluent. Researchers analyzed death cer- 
tificates of Los Angeles County residents from 
1979-1981. Those who made less than $13,600 
were classed as poor and those who made more 
than $28,501 were designated affluent. The 
death rate from heart disease was 40% higher 
for the poor than the affluent. The study also 
found that the poor are more likely to die out 
of the hospital. Dr. R. R. Frerichs, a member 
of the study group, speculates that the high 
rate among the poor may be due to not getting 
checkups, not having health insurance, not 
being able to afford health care, and delaying 
treatment. 



194. Author: Beyette, B. (1984, December 11). 

Title: Alternative childbirth center assists Latinos. 

Source: Los Angeles Times , Part V, pp. 1, 6, 7. 

Abstract: This article reports on the Los Angeles Child- 
birth Center that offers assistance to Latinos 
in an Alternative Childbirth Center (ABC) in 
Santa Monica, which has a population of 88,000, 
including 13,000 Latinos. The city supports 
the Center, founded in 1977, but will withdraw 
its support in 1985, at which time it is expect- 
ed to be self-supporting. The non-profit 
organization has a Latina Maternity Care Pro- 
gram which is intended to attract Latinas who 
would otherwise give birth at home without 
proper prenatal and postpartum care. The pro- 
gram includes the ABC Center as well as classes 
in natural childbirth. The staff of 13 includes 
the medical director and two nurse-midwives . 
The birth can take place in the home or in the 
Center. The ABC with two birthing rooms is 
available to all women. Fees are based on 
income, and very poor families can use Medical. 
Fees charged are compared with those of private 
institutions. Should a problem develop, the 
patient is moved immediately to a public or 
private institution for specialized care. Mor- 
tality rates compare to those of other hospi- 
tals. There have been no preventable deaths of 
infants and no deaths of mothers. According to 
Nina Kleinberg, one of the nurse-midwives at 
the Center, Hispanic women, especially from 
rural areas, have different attitudes about 
childbirth, being more relaxed and accepting 



189 



childbirth as a natural part of life. Dr. Gary 
Richwald, The Center's medical director, parti- 
cipates in all initial patient evaluations and 
is a consultant on an ongoing basis until de- 
livery with a nurse-midwife. He spoke of the 
need to decentralize health services and to 
reduce the financial stress of having a baby in 
the Los Angeles area. With the emphasis on 
childbirth being a "family event," the Center 
is reaching out to the community in an effort 
to become self-sustaining. 



195. Author: Carmen, A. (1983). 
Title: Rape. 

Source: Latina, 1(23), 35-36. 

Abstract: This article discusses the rape problem as it 
affects Latinas. The cultural, social, and 
economic realities of life can make rape a 
particularly devastating experience for the 
Hispanic woman. The importance of chastity, 
the reluctance to discuss sex openly, and the 
strong separation of male and female roles lead 
to an aggravated sense of humiliation and 
guilt. Family and friends often reject the 
victim. Factors that inhibit reporting of rape 
are: family and neighborhood loyalty, reluctan- 
ce to report neighbors and relatives, language 
barriers, working women afraid of losing their 
jobs who are raped by their supervisors, un- 
documented women who are afraid of deportation 
when attacked by immigration officials or 
others. These all make Latinas less likely to 
report the crime or get medical or psychologi- 
cal help. In addition to the above, Latinas 
are ten times as likely to be gang raped as 
Anglo women. Formation of the East Los Angeles 
Rape Hotline was necessary to provide services 
from the only bi-lingual/bi-cultural hotline 
including crises intervention, follow-up coun- 
seling, advocacy, community education and vol- 
unteer training services. Women who might be 
reluctant to turn to help to other services 
call the East Los Angeles Rape Hotline at a 
rate of 30 to 40 each month. Calls are received 
24 hours per day, 365 days per year, by a staff 
of 35 trained volunteers. The article lists 
precautionary activity as well as what a woman 
should do if she is sexually assaulted. 

196. Author: Escalante, V. (1984, May 2). 

Title: Latino play on sexual abuse moves community. 
Source: Los Angeles Times , View Section, pp. 1, 16. 



190 



Abstract: A report on the work of the Latino Child Sexual 
Abuse Prevention Project, which is aimed at 
reaching all segments of the Latino community 
with information on child abuse. The project, 
which began in July 1984 and is due to end in 
June, has undertaken the following: 1) inten- 
sive training of elementary school teachers, 2) 
a pilot program using stories and puppets to 
teach children, 3) creation of a network of 
schools, health and social agencies, 4) compi- 
lation of a referral list of bilingual/bicul- 
tural health counseling and police agencies for 
parents, and 5) presentation of a play on child 
abuse within a Latino family. This is the 
first program of its kind in the nation and is 
a creation of the Latino Child Sexual Abuse 
Prevention Project. 



(1984, November 18). 

Hispanics have greater diabetes 



197. Author: Fatherree, T. 

Title: Study shows 
risk. 

Source: The Monitor , Valley Section, pp. 17A, 27A. 

Abstract: A report of a study conducted by the University 
of Texas Health Science Center in Houston es- 
tablished that the Mexican American population 
of the Rio Grande Valley has an increased risk 
of diabetes. Representative sampling produced 
2,498 individuals over 15 years of age. These 
subjects were interviewed, tested for blood 
pressure and underwent finger-prick blood sam- 
pling. About one-third of the household tar- 
geted for interviews refused to cooperate. 
Interviews continued until 10% of the county 
population had participated. Results showed 
prevalence of diabetes from to 19% with fe- 
males generally having higher rates than men. 
It is believed that more than 50% of indivi- 
duals over 35 years of age are directly af- 
fected by diabetes, either by having the dis- 
ease or by someone in their family having the 
disease. It is not clear whether the increased 
rate is attributable to genetic predisposition 
or to sociocultural factors, or both. 



198. Author: Goldstein, I. (1984, January 14). 

Title: Why asthma hits some minorities hardest. 

Source: New York Times , pp. 16 (N), 10 (L). 

Abstract: A commentary on a University of Connecticut 
study in which the researchers assert that 
Puerto Ricans suffer twice as much asthma (10%) 
as other ethnic groups or twice the U.S. rate. 
The author cites a Columbia University study 



191 



done in New York (Brooklyn, Manhattan, Harlem) 
which found similar rates among Black adoles- 
cents in Harlem. These studies seem to supply 
strong evidence that housing conditions rather 
than ethnic susceptibility are responsible for 
high rates of asthma in inner city populations. 



199. Author: Gunby, P. (1984). 

Title: Medicine at a glance. 

Source: Journal of the American Medical Association , 252 
(24) , 3349. 

Abstract: Describes phase II of the National Heart, 
Lung, and Blood Institute of Bethesda, Maryland 
sponsored study that compares incidence of 
diabetes, heart disease, and high blood pres- 
sure in two ethnic groups in San Antonio, Texas. 
This study is evaluating frequency and severity 
of diabetic complications, relation of upper 
body fat deposits to diabetes, and possibility 
of genetic factors in diabetes. Phase I, 
headed by Michael P. Stern, M.D. University of 
Texas Health Science Center, San Antonio, found 
that diabetes is three to five times more pre- 
valent in Mexican Americans. Although it is 
hypothesized that genetics play a role, it is 
also known that culture and dietary factors are 
involved. 



200. Author: Nelson, H. (1985 May 1). 

Title: County high blood pressure deaths top U.S. rate 
by 53%. 

Source: Los Angeles Times , Metro , pp. 1, 3. 

Abstract: Report of a study completed last year by the 
UCLA School of Public Health indicates that the 
death rate from hypertension diseases has in- 
creased to 53% over the national average. Hy- 
pertension disease death in Los Angeles County 
from 1979-1981 were 20.3 per 100,000 compared 
to the national average of 13.3 per 100,000 
during the same time. Although Blacks are at 
higher risk than either Whites or Latinos, the 
death rate for all three groups and the Chinese 
population were above the national average. 
Los Angeles averages per 100,000 were 18.7 for 
Whites, 47.7 for Blacks, 19.9 for Latinos, and 
17.1 for Chinese. Hypertension is the most 
important risk factor in deaths from heart 
attacks, strokes, and heart and kidney disease. 
Survey also revealed that only 6 out of 10 
individuals with high blood pressure are aware 
of it. 



192 



201. Author: Nelson, H. (1982, November 17). 

Title: Drop in TB rate may mean hidden cases. 

Source: Los Angeles Times , Part 2, p. 5. 

Abstract: This report looks into the significance of the 
drop in the tuberculosis rate among Hispanics 
in Los Angeles County. Some experts think that 
the 31% drop in cases in 1982 is because His- 
panics are simply failing to report existing 
cases. Shirley Fannin, the Assistant Director 
of the Communicable Disease Division of the 
Department of Health Science, Los Angeles Coun- 
ty, believes that Hispanics don't report be- 
cause they are unaware treatment is free, or 
they are afraid of deportation. She states 
that the average number of cases among Hispan- 
ics in 1980-81 was 521 and in 1982 was 357. 
This difference, she feels, cannot realistically 
be attributed to a decline in the incidence of 
the disease. Emily Kahlstrom, a lung expert at 
the U.S.C. Medical Center, concurs. She cites 
the 128% increase of infection between 1970 and 
1981-82 in school age children as a basis for 
requiring tuberculosis skin tests upon entering 
school or employment. 



202. Author: Nelson, H. (1983, September 29). 

Title: Heart, stroke, death rates found to vary. 

Source: Los Angeles Times , Sec. II , p. 1. 

Abstract: A UCLA study sponsored by the American Heart 
Association's Greater Los Angeles Affiliates 
reported on the death rates of different racial 
and ethnic groups in Los Angeles County. Re- 
searchers examined all causes of death based on 
the census tracts and death certificates in the 
County and found major differences in death 
rates between racial and ethnic groups. John 
Chapman, who headed the group, reported that 
although deaths from cardiovascular disease are 
down as a whole, the rate among Blacks is the 
highest. The rate among Anglos is just behind 
that of Blacks. Latinos have a somewhat lower 
rate with 390.6 per 100,000 succumbing to car- 
diovascular disease. 



2 03. Author: 
Title: 
Source: 



Nelson, H. (1985, February 21) . 
Poverty kills, new heart study finds. 
Los Angeles Times , Sec. I, p. 3. 
Abstract: A study sponsored by the American Heart Asso- 
ciation on heart disease was a follow up to an 
earlier study in September of 1983 which indi- 
cated a high mortality rate for cardiovascular 



193 



disease for Blacks. The new study was based on 
mortality rates in Los Angeles County in 1979- 
1981. These rates were analyzed according to 
sex, race, ethnicity, and income level. The 
study found that the poor, regardless of race 
or ethnicity, were 40% more likely to die of 
heart disease. The out-of -hospital death rate 
for the poor was also high. Researchers specu- 
late that lack of access to emergency care, 
less awareness of the need to control heart 
disease factors, and consumption of high-risk 
foods contribute to the high rate for the poor. 
Among all income groups the heart disease death 
rate for Latinos was 370 out 100,000. 



204. Author: Nelson, H. (1982, May 16). 

Title: TB rate among Southeast Asians, Latinos in U.S. 
higher than average. 

Source: Los Angeles Times , Part I, p. 17. 

Abstract: This report on the tuberculosis rate among 
Latinos and Southeast Asians by the Centers for 
Disease Control states that the tuberculosis 
rate among Latinos is double that of the gener- 
al population. Among Southeast Asians, the 
rate is forty times greater. In California, 
42% of the 3,099 cases of tuberculosis are 
among Latinos. Lee Hanh, Director of Tubercu- 
losis Control for Los Angeles County, reports 
that in 1980 there were 1,431 reported cases of 
tuberculosis; of these, 608 were among Hispan- 
ics. In 1981, the number increased to 1,808 
of which 775 were Hispanic. He adds that lit- 
tle is being done for Latinos in comparison to 
Southeast Asians who receive federal aid 
and special programs. Dr. Einstein of the 
Barlow Hospital states that the staff of that 
facility is attempting to provide some preven- 
tive services that had formerly been provided 
by the County before recent cutbacks. 

205. Author: Nicols, B. (1982, May 16). 
Title: Chicanos warned on diabetes. 
Source: Los Angeles Times , Part I p. 3. 

Abstract: A study administered through the National In- 
stitues of Health has found that Hispanics may 
be three times as likely to develop adult onset 
diabetes as Anglos. Among 1,924 Mexican Ameri- 
can residents of Starr County, Texas, over age 
15, 130 cases of diabetes were found. Dr. 
Ferrell, one of the researchers, states that 
Indian ancestry is suspected as a cause. 

I.D.No.: 26C 



194 



206. Author: Olvera-Stotzer, B. (1984, January). 

Title: Women ' s health: A Latina perspective . 

Source: Testimony presented to U.S. Department of Health 
and Human Services Task Force on Women's Health. 

Abstract: This paper presents problems within the current 
system of health care delivery for Latinas, as 
seen by Comision Femenil Mexicana Nacional, 
Inc. These problems are frequently caused by 
isolated decisions made without consideration 
of the cultural background of Latina women, and 
the effect not only on them but on the entire 
community. Information is given on abortion, 
utilization and Medicaid funding restrictions. 
Characteristics of Latinas are given as ethni- 
city, young age, low socioeconomic status, and 
high fertility. Medicaid funding is analyzed, 
including legal issues surrounding the abortion 
decision, and an assessment is made of the 
social and psychological impact of these is- 
sues. Discussion centers on funding of abor- 
tions under Medicaid, and problems created by 
not having such funding. Outlined are the 
results of unwanted childbearing, teenage child 
bearing, and childbearing by middle age women. 
Three recommendations are made for assuring 
equitable distribution of health services: 1) 
development of incentive programs to encourage 
physicians to practice in medically underserved 
communities, 2) encourage and support health 
planning programs, and 3) stricter monitoring 
and enforcement of federal as well as state 
statutes and regulations prohibiting discrimi- 
nation on the basis of national origins. 



207. 



Author : 

Title: 

Source: 



Orijel, J. (1984, January). 

Women ' s health: A Hispanic perspective . 



Paper presented to the Department of Health and 
Human Services Task Force on Women's Health. 
Abstract: This paper was presented to give some under- 
standing of the variety of problems facing His- 
panic women and issues relevant to their health. 
Dr. Fernando Guerra (1980) stated that Hispan- 
ics exist in more stress-producing situations, 
have higher morbidity and mortality rates, at- 
tend substandard schools, have higher dropout 
rates, higher unemployment rates, poor housing, 
poor nutrition, higher incidence of poverty and 
a shortage of relevant and accessible health 
care services. Priority issues for Hispanic wo- 
men are prenatal health care, preventive health, 
nutrition, and bilingual and bicultural health 
services. The major Hispanic subgroup in the 



195 



Southwest is Mexican American. Eighty percent 
are in the dependent age ranges (under 16 and 
over 64), with only 3.3% over 65. Acculturation 
has changed the traditional pattern of high 
fertility. Income and education levels in this 
subgroup are lower than that of the greater 
population. The most common cause of death 
among Mexican American women is heart disease, 
but tuberculosis, infectious and parasitic 
diseases take a higher toll than in the Anglo 
population. Cancer of the cervix has been ob- 
served to be freguent in this population; dia- 
betes and hypertension are a major concern. 
The status of nutrition is similar to that of 
other predominantly low income groups. Cultur- 
al influences account for dependency on home 
remedies and folk healers for primary health 
care. Recommendations are: 1) Priority given 
to a comprehensive national health insurance 
for everyone with emphasis on preventive health 
services, 2) funds for maternal and child 
health should be encouraged and reimbursement 
for new approaches for prenatal care, deliver- 
ies and post-partum care should be provided, 
3) funds be allocated for the identification of 
Hispanic data in health research, and 4) funds 
for direct services programs be prioritized to 
community non-profit groups in order to reflect 
culturally sensitive health care. 



208. Author: Sahagun, L. (1983, April 20). 

Title: Diabetes: a special risk for Latinos. 

Source: Los Angeles Times , Part I, p. 11. 

Abstract: This study, done by Robert Ferrell and Michael 
Stern, University of Texas researchers, provid- 
es the first statistical evidence of a higher 
risk of diabetes among Hispanics. In the Lower 
Rio Grande Valley, 27,000 residents were sur- 
veyed and subjected to a socioeconomic cross 
study. The results indicate that Mexican Amer- 
icans of South Texas are five times as likely 
to develop adult onset diabetes as Anglos. The 
cross study established that socioeconomic dif- 
ferences did not explain the gap. The research- 
ers believe a genetic link to Indian ancestry 
could be responsible. Dr. Brown asserts that 
there is an urgent need to reach Hispanics with 
this information and to make sure this group 
receives the proper care. Dr. Bennet, whose 
1970' s studies are confirmed by this report, 
agrees and also says there is a need for more 
studies on Hispanic health issues. Many doctors 
who practice in the barrio think this study re- 



196 



fleets the reality they encounter. The American 
Diabetes Association of East Los Angeles is at- 
tempting to bring the Texas studies to the at- 
tention of Hispanics through Spanish-language 
television, but feels its efforts are being 
seriously hampered by recent severe cutbacks. 
Another study to be administered by the National 
Center for Health Statistics is planned to con- 
firm or deny these results. 



209. Author: Staff. (1983, Summer). 

Title: Child abuse. 

Source: Research Bulletin , (Spanish Speaking Mental 
Health Research Center) p. 4. 

Abstract: Report of a study conducted in Los Angeles 
County of child abuse cases by K. J. Lindholm, 
UCLA, and Richard Wiley, Los Angeles County 
Sheriff's Office, to determine whether there 
were differences related to the ethnicity of 
the victim or suspect. The study indicated 
that although there were differences in the 
rate and type of abuse, type of injuries suf- 
fered, or who reported the incident based on 
ethnicity, there is a need for more systematic 
research of the relationship between ethnicity 
and child abuse. 



210. Author: 
Title: 
Source: 
Abstract; 



Staff. (1984, November 19). 
Congenital syphilis study. 
Hispanic Link Weekly Report , p. 2. 
A study reported in the October 5, 1984, Jour- 
nal of the American Medical Association indi- 
cates that congenital syphilis, passed from 
mother to child, could be reduced among Hispan- 
ics and Blacks with increased prenatal care. 
The study group consisted of 50 cases in Texas 
in 1982, of which 27 were Hispanic and 23 were 
Black. The Texas Hispanics made up 17% of the 
159 cases reported nationally. 



211. Author: 
Title: 
Source: 

Abstract: 



Staff. (1983, Summer). 

Hispanic mothers less likely to smoke. 

Research Bulletin (Spanish Speaking 



Mental 



Health Research Center), pp. 2-3. 
More than 7,000 mothers and their physicians 
were surveyed by the National Institute on 
Alcohol and Alcoholism and the National Center 
for Health Statistics. The survey consisted of 
questions regarding pregnancy, history, and 
outcome, and a review of medical records. Two 
groups were surveyed: those who had success- 



197 



fully delivered in the past and those with 
stillborn deliveries. The survey found little 
difference in cigarette or alcohol use between 
the two groups. One-fifth of the mothers 
smoked and drank before pregnancy and one-third 
abstained from cigarettes and alcohol. Race, 
education, and income levels had some bearing 
on smoking/drinking habits of pregnant women. 
Hispanic mothers are less likely to be drinkers 
or smokers before and during pregnancy. 



212. Author: Staff. (1983, Summer). 

Title: Mexican Americans and diabetes. 

Source: Research Bulletin , (Spanish Speaking Mental 
Health Research Center), p. 2. 

Abstract: Reports of two separate studies conducted by 
Drs. Robert Ferrell and Michael Stern with 
Mexican Americans in Texas, revealed that 16.7% 
of Mexican Americans in South Texas had adult 
diabetes and 6.8% of the residents of Starr 
County, Texas, had the disease. Dr. Ferrell* s 
hypothesis is that the higher incidence may be 
related to the fact that many Texas Mexican A- 
mericans are of mixed Indian and European des- 
cent. Dr. Stern suspects a genetic basis for 
the increased prevalence in Mexican Americans 
over Anglo Americans. 



213. Author: Staff. (1983, December 28). 

Title: Puerto Ricans have high asthma rate study 
concludes. 

Source: New York Times. Sec. A, p. 21 (L) . 

Abstract: A study done by the University of Connecticut 
reports the first scientific confirmation that 
Puerto Ricans suffer a higher rate of asthma 
than other ethnic groups. Researchers did a 
door-to-door survey among 1,079 (55% Puerto 
Rican) families in Hartford's Oak Terrace 
Heights Housing Project in 1981. Data revealed 
that 10% of the Puerto Ricans surveyed had 
asthma, twice the national average, with 38% of 
the Puerto Rican families having at least one 
family member with asthma. The study concludes 
that Puerto Ricans suffer from asthma twice as 
much as other northeastern ethnic groups. 



214. Author: Staff. (1985, March). 
Title: Reye syndrome. 
Source: The COSSMHO Reporter , p. 3. 
Abstract: The U.S. Department of Health and 
vices' Center for Disease Control 



Human Ser- 
reports a 



198 



significant increase in Reye Syndrome among 
Hispanics. As of December 1, 1984, 7% of the 
voluntarily reported cases (196) were Hispan- 
ics. Five cases were in Texas, four in Cali- 
fornia, two in Colorado, and one in the Dis- 
trict of Columbia. Studies suggest a link 
between the use of aspirin products and Reye 
Syndrome. The Department of Health and Human 
Services urges everyone to check with their 
doctors, learn the symptoms, and act promptly. 



215, 



Author : 

Title: 

Source: 

Abstract: 



Staff. (1984, Spring/Summer). 
Sexual Abuse. 

Research Bulletin (Spanish Speaking 

3-4. 



Mental 



Health Research Center) , pp. 
Study of child abuse within Hispanic, Black and 
Anglo families based on 611 cases investigated 
by the Los Angeles County Sheriff Department's 
Child Abuse Detail from January 1981 through 
November 1982. The study reports ethnic differ- 
ences in relation to suspect, victim and infor- 
mant. 



216. Author: Staff. (1984, Spring/Summer). 

Title: Smoking. 

Source: Research Bulletin , (Spanish Speaking Mental 
Health Research Center), p. 5. 

Abstract: A report on the methods and goals of a 1984 
research project on cigarette smoking among 
Hispanic and White Americans in Los Angeles 
County, conducted by the Seventh Day Advent ist 
Church and the Spanish Speaking Mental Health 
Research Center. 



217. Author: Staff. (1984, July 2). 

Title: T.V. proves successful in reaching Spanish 
Speaking. 

Source: Cancer Corn-Line , 5(2), p. 1. 

Abstract: The University of Southern California Cancer 
Center participated in a nationwide pilot 
program designed to reach the Spanish Speaking. 
Spanish language services were presented on the 
Cancer Information Service hot-line. Materials 
in Spanish were distributed through health 
fairs, Roman Catholic churches, professional 
agencies and the staff made public and televi- 
sion appearances on a Spanish-language station 
in Los Angeles, urging the Hispanic community 
to utilize a cancer information hot-line. From 
November, 1983, through March, 1984, 559 Span- 
ish speakers called. Of these, 80% said they 



199 



were calling as a result of the television 
appearances. Findings indicate that when Span- 
ish-speaking Hispanics are reached through 
utilization of the proper media, use of their 
own language and people of their own heritage, 
they will ask for cancer information and help. 



200 



Subject Index 



201 



202 



SUBJECT INDEX 

Abortion 206 

Acculturation 20, 30, 68, 93, 94, 105, 119, 120 

Acute Otitis Media 164 

Addicts 98 

Female 54, 55, 56, 57 

Heroin 49, 54, 56, 57, 102 
Admixture 19, 65 
Adolescents 1, 8, 35, 45, 50, 99, 109, 137, 138, 151, 191, 

198 

Black Female 117 

Hispanic Female 117 

Teen age mothers 181 
Adults 6, 8, 14, 15, 17, 18, 20, 26, 34, 38, 39, 40, 42, 45, 

51, 52, 54, 55, 60, 63, 69, 90, 97, 110, 135, 137, 149, 

166, 177, 184, 188, 207, 212 

Abusive 139, 152 

Older 151 

Young 56 
Adult onset diabetes 19, 205, 208 
Age 

Gestational 47 

Maternal 47 
Alabama 180 
Alcoholism 5, 6, 20, 48, 52, 88, 115, 151, 161 

Alcohol 34, 39, 50, 89, 99, 125, 188 

Alcoholics Anonymous 115 

Epidemiology 137, 151 
Alternative Cancer Treatments 9 
Amebiasis 146 
Anecedotal Studies 13 
Anemia 

Congenital pernicious 121 

Megaloblastic 121 
Anglo 9, 17, 19, 20, 26, 27, 31, 32, 34, 42, 46, 58, 60, 67, 

81, 83, 87, 102, 109, 139, 153, 168, 172, 191, 195, 

203, 206, 216 

American, 19, 30, 119, 162, 199 
Anthropometry 42, 45, 74, 104, 117 
Anti-Cra 171 
Apgar 47 

Archival Study 175 
Arizona 12, 64, 88, 109, 208 
ARSMA acculturation scale 13 
Arthritis 131,141, 142 

Gouty 83 

Juvenile Rheumatoid 171 

Psoriatic 83 

Rheumatoid 3, 71, 83 



203 



Asian 57 

Southeast Asian 205 
Asthma 12, 166, 198, 213 
ATS-DLD-78 (Fe 78) 59, 60 
Attitudes 67, 69, 78, 172, 184 
Autoimmune Disease 16 
Autoimmunity 76 
Azarcon 62, 84, 159, 173 
Beliefs 78 
Behavior 78 
Bicultural 19 
Birth Weight 47 
Black 9, 16, 22, 26, 29, 41, 43, 48, 49, 55, 56, 57, 71, 81, 

83, 89, 91, 97, 99, 102, 107, 123, 129, 133, 134, 136, 

198, 203, 204, 211, 216 
Bradley Method 194 
Breast feeding 118,162 
Buss-Durkee Hostility Inventory 123 
Cadaveric Renal Allografts 168 
California 2, 5, 13, 16, 20, 22, 29, 33, 38, 39, 44, 46, 47, 

51, 54, 55, 56, 57, 65, 72, 75, 76, 79, 82, 84, 89, 90, 

95, 96, 98, 104, 106, 108, 110, 112, 118, 121, 122, 123, 

124, 125, 127, 130, 132, 139, 141, 142, 144, 145, 147, 

148, 149, 150, 154, 158, 159, 165, 175, 187, 188, 190, 

191, 192, 193, 194, 195, 196, 201, 202, 203, 204, 205, 

207, 208, 209, 210, 214, 215, 216, 217 
Cancer 97, 144, 153, 187, 190, 191, 217 

Adolescent 138 

Biliary tract 44 

Breast 153 

Colon 153 

Colorectal 172 

Diagnosis 163 

Gallbladder 11, 44, 73, 86 

Kidney 86 

Liver 86 

Lung 36, 58, 145 

Oral 86 

Skin 129,163 

Treatment 9,78,163 

Uterine 33, 207 
Cardiovascular Disease 25, 29, 53, 63, 64, 68, 110, 120, 

177, 193, 200, 202 

Risk Factors 24, 42, 63, 64, 120, 176 
Case Control Study 2, 4, 11, 23, 36, 48, 59, 73, 100, 183 
Caucasian 71, 130, 136 
Cysticercosis (CNS) 170 

Cerebral Cysticercosis 22, 95, 132, 147, 148, 149, 150, 170 
Chemical Dependency 15, 17, 34, 52, 90, 113 
Child Abuse/Neglect 69, 111, 139, 152, 165, 183, 184, 209, 

215 

Abuse, causative factors 152 

Abuse, Indication of 152 

Abusive parents 152 



204 



Intergenerational influence 152 
Child care 61 
Child advocacy 184 
Child rearing practices 69, 167, 184 

Children 9, 12, 26, 35, 62, 80, 84, 104, 111, 160, 164, 182, 

196 

Migrant 159 
Children's Blood Pressure 25 
Chinese American 29 
Chicanos 108, 196 
Cholecystectomy 73 
Cholesterol 27, 64, 68 
Clinician/Patient Interaction 78 
Chromium-labeled incompatible red cells 171 
Clinical Features 71 
Colitus, Ulcerated 146 

Colorado 7, 84, 88, 93, 128, 158, 208, 214 
Combat Stress Scale 13 
Comparative Study 55 
Congenital Anomalies 178 
Congenital Heart Disease 178 
Congenital Syphillis 43, 210 
Connecticut 214 
Coping Mechanisms 38, 161 

Coronary Heart Disease 31, 32, 94, 120, 141, 199, 207 
Cross Cultural 9, 20, 26, 38, 39, 42, 52, 63, 135, 137, 177, 

208 
Cross Generational 6 
CSF IgE level 22 

Cubans 41, 78, 87, 94, 114, 117, 161, 177 
Cultural Factors 20, 114, 161, 196, 207 

Chicano Culture 196 
Dapsone Therapy 86 
Data Collection Instrument 21 
Day Care 111 

Demographic Study of Women 207 
Dental 80 
Depression 15, 46, 61, 141 

CES-D Depression Scale 46 
Diabetes Mellitus 14, 18, 23, 24, 26, 46, 65, 68, 69, 75, 

76, 107, 119, 120, 140, 197, 199, 212 

Adult Onset Diabetes 19, 205, 208 

Complication of 212 

Diabetes Type II (non- insulin dependent) 28, 37, 45, 66, 

76, 119, 130, 140 
Dieting Behavior Scale 67 
District of Columbia 214 
Domestic Violence 93 
Dominican 78, 115 
Drinking 5, 112, 188, 211 
Drugs 21, 143 

Abuse 50, 98, 101, 161 

Addiction 38, 49, 54, 55, 56, 57, 135 



205 



Consultation 101 

Prescription Drugs 114 

Treatment 98, 143 

Use 114 
E Coli 23 

Education, levels of 50 
Elderly 41, 77, 141, 189 
Empacho 62, 84, 159, 173 
English Speaking 110 
Entamoeba histolytica 146 
Enviroment 20, 94, 97, 166 

Epidemiology Methods/ Studies 14, 88, 108, 126, 178 
Ethnic Comparisons 8, 25, 89, 109 
Ethnic Differences 136 

in HLA with RA 3 
Ethnicity 21, 29, 81, 162, 168, 178, 191, 198, 203 
Ethnographic Study 54, 112, 114 
Families 111, 113, 121 
Family Interaction Scale 4 
Family relations 20, 179 
Farm Laborers 69, 155 
Fat Avoidance 27 
Fat Patterning 45 
Female 6, 8, 15, 20, 21, 29, 33, 34, 36, 37, 38, 39, 40, 41, 

44, 48, 54, 55, 56, 57, 61, 73, 80, 81, 88, 94, 118, 122, 

127, 130, 136, 137, 144, 145, 151, 153, 156, 159, 162, 

172, 187, 188, 192, 197, 207, 208 
Fetal Monitoring 154, 156 

Protocals 154 
Filipina 57 

Florida 1, 8, 41, 65, 83, 87, 94, 106, 114 
Folacin 1 

Folk Medicine 62, 84, 103, 140, 159, 173 
Food 

Preferences 134 

Purchases 134 

Sugar 67 
Foreign vs U.S. Born Hispanic Females 43 
Gallbladder Disease 73, 107 
Gallstones 11, 73, 107 
Gangrene 23 
Gangs 113, 143 
Genetic 19, 73, 121, 208 

Predisposition 65, 122 
Geographic Area 19, 21, 94, 131, 169, 178, 180 
Glucose Tolerance 19 
Glycosylated 14 
Greta 173 

Growth Retardation 7 
Guatemalans 115 
Halothane Hepatoxicity 122 
Hansen's Disease 86, 116 

Protocal 116 
Health Care Agencies 



206 



139, 


141, 


144, 


168, 


171, 


172, 


186, 


187, 


190, 


203, 


204, 


205, 



Public 78 

Voluntary 78 
Health Delivery Systems 40, 51, 172, 206 
Health Education 33, 35, 140, 189 
Health Screening 25, 128 
Health Status 105, 106, 119 
Health Utilization 126 
Hematochezia 146 
Hemoglobin 14 

Abnormal 124 

Testing for variant 124 
Hepatomegaly 146 
Heroin 54, 56, 57, 103, 113, 143 

Addiction 49, 55, 57, 157 

Non-medical Intervention 103 

Treatment 102, 103 
Hispanic 1, 2, 5, 8, 9, 13, 21, 25, 29, 33, 36, 43, 44, 48, 

58, 59, 60, 62, 65, 77, 78, 86, 88, 89, 90, 91, 93, 94, 

97, 98, 99, 100, 102, 103, 106, 111, 115, 116, 124, 126, 

128, 129, 131, 132, 133, 134, 137, 138, 

151, 153, 156, 157, 158, 160, 161, 164, 

173, 174, 175, 179, 180, 181, 182, 185, 

191, 192, 194, 195, 196, 200, 201, 202, 

207, 210, 211, 212, 215, 216, 217, 218 
Hispanic Female Characteristics 43, 206 
Hispanic Health and Nutrition Examination Survey 85 
Hispanic Risk for Cogenital Syphillis 43 
Histocompatability Antigens 75 
HLA 16, 72, 168 

HLA-DR4 3, 71, 75 

HLA Phenotype 10 

HLA Typing 75 
Home hemodialysis 100 
Homicide 99 
Household Survey 32 
Hydrocephalus 132 
Hypertension 24, 25, 53, 94, 120, 133, 141, 176, 180, 197, 

199, 200 
IgA 2 

IgG Insulin Antibodies 75 
IgM 2 

Illinois 16, 113, 124, 158, 179 
Immigrant 20, 132, 148, 165, 169 

Immigration 51 

Women 114 
Immunodeficiencies 86 
Immunization 174 
Immunology 148 
Income 

Low 1, 19, 61 

High 19 
Indigenous Therapy 115 
Infants 40, 47, 178, 181 

Feeding Practices 87 



207 



Hispanic 43 

Maternal Infant Care Practices 192 

Mortality Rate 169 

Neonatal Sepsis 96 

Newborn 185 
Infectious Diseases 2, 207 
Inhalants 50 
Inhalant Users 4 

Insulin-Dependent Diabetes Study 75 
Interviewing Techniques 78 
Intestinal Disturbance 159, 173 
Intestinal Parasites 79 
Intercultural Variations 112 
Iron 1 

Kentucky 102 
Lactation 118 
Laetrile 9 

Language Development 167 
Lead Poisoning 62, 84, 159 
Lead Tetroxide 62 
Leprosy 116 
Lipoproteins 68 
Louisiana 86 
Lupus Nephritis 182 
Male 6, 8, 15, 17, 20, 29, 36, 37, 38, 39, 48, 52, 55, 57, 

59, 80, 88, 94, 130, 136, 137, 144, 145, 153, 172, 188, 

197 
Malignant Melanoma 129, 163 
Marijuana Use 50 
Marriage 20 
Massachusetts 101, 155 
Maternal 

Behavior 61, 181 

Bonding 181 

Expectations 167 

Infant Care Practices 192 

Response 61 

Risk 169, 211 

Tactile Content 185 

Teen Age 117, 181 
Measles 174 
Media 53, 217 

Medical Records Review 11, 158 
Mental Health 15, 61, 161 
Mental Health of Mexican Women 61 
Methadone 54 
Mexican 47, 61, 71, 79, 82, 111, 112, 118, 127, 132, 150, 

148, 152, 169 

Mestizo 3, 143 

Mexican-Indian 122, 124 

Mexican American 4, 7, 10, 11, 12, 14, 16, 18, 19, 20, 22, 

24, 26, 27, 28, 30, 31, 34, 36, 37, 38, 42, 45, 46, 50, 

53, 55, 63, 64, 65, 67, 68, 69, 70, 72, 73, 74, 75, 76, 

80, 81, 84, 92, 94, 96, 103, 104, 105, 107, 109, 111, 112, 



208 



118, 119, 120, 121, 122, 123, 125, 130, 136, 140, 143, 

146, 147, 149, 152, 161, 162, 169, 176, 177, 178, 183, 

184, 189, 197, 199, 206, 208, 209, 213 

Mexican Origin 14, 32, 108, 154 
Mexican Problems in Life Conditioning 61 
Michigan 158 

Michigan Alcoholism Screening Test 52 
Migrant 7, 61, 69, 111, 155, 183, 184 
Minnesota 158 
Mississippi 180 
Missouri 180 
Morbidity (Pedal) 83 
Mortality Rates 209 

Alcohol 137 

Cardiovascular 29, 193, 202, 203 

Coronary Heart Disease 94 

Diabetes 70 

Infant 169 

Maternity 158, 194 

Neo-natal 169 

Out of Hospital Death Rate 203 

Post Neo-natal 169 

Renal 168, 182 
Motivation 17 

Multidisciplinary Genetic and Epidemiology Study 37 
Native Americans 19, 57, 65, 73, 137, 184, 186, 206, 209 
Natural Childbirth 194 
Neighborhoods Poor/Wealthy 29 

Neurological Disease 22, 95, 132, 147, 148, 149, 150 
New Jersey 94, 158 
New Mexico 36, 52, 58, 59, 60, 88, 126, 129, 145, 158, 163, 

172, 180, 190, 208 
New York 17, 18, 19, 48, 56, 57, 65, 78, 91, 94, 100, 106, 

117, 131, 166, 174, 182, 198, 208 
NIMH Diagnosic Interview Schedule 13 
Non-Hodgkin ' s Lymphomas 72 
Nursing Implications 33, 140, 167 

Care 47 
Nutrition 68, 77, 85, 94, 97, 104, 110, 117, 133, 134, 153, 

179, 186, 207 

Policy 85 

Research 85 
Obesity 18, 30, 45, 64, 66, 67, 74, 94, 107, 117, 119, 120, 

186, 197 
Occupational History 59 

Health 65, 106 
Ohio 16 

Opioid Use 143 
Outpatient Care 48 
Ovulation 2 
Pain 136 

Pancreatic ICA 76 
Pap Smear 33 
Parasitic Infestation 22, 95, 146, 147, 150, 154, 170, 207 



209 



Parenting 61 

Parity Correlates 44 

Patient Education 142 

Patient Non-compliance 78 

PCP 50,91 

Pediatrics Surveillance Study 186 

Pennsylvania 180 

Pericentric Inversion of Chromosome 8,178 

Perinatal 154, 156 

Distress 156 

Outcome 156 
Personality Inventory 49 
Pesticides 82 

Physician/Patient Relationship 9, 138, 164 
Physiological Changes in Aging 77 
Pima Indians 64 
Plasma Glucose 30, 66 
Post Coital Tests 2 
Posttraumatic Stress Disorder 13 
Pregnancy 40, 51, 96, 127, 158, 189 

Fatty Liver of Pregnancy Disorder (FLPD) 158 

Middle Age 206 

Pre-natal care 43, 47, 210, 211 

Teenage 206 

Ultrasound 156 
Pre-natal and Intrapartum High Risk Screening System 47 
Pre-school 7,167,174 
Prevalence Study 28 

Cysticercosis 148 

Diabetes 65,197 

Growth Stunting 186 

Hansen's Disease 116 

Survey 59,79 
Preventive Behavior 31 
Prevention 32, 53 
Primary Prevention 161 
Prisoners 123 
Prospective Study 2 
Psychosocial Adjustment 137 
Psychological Adjustment 38, 161, 191 
Public Health Education 53, 120 
Public Health Problem 82 
Puerto Rican 8, 17, 78, 87, 94, 101, 113, 115, 135, 155, 161, 

166, 167, 177, 190, 198, 214 
Pulmonary Function 12 
Questionnaire 59, 105 
Racial Characteristics 71 
Rape 195 

Gang Rape 195 

Rape Hotline 195 
Recommended Dietary Allowances (RDA's) 117 
Rehabilitation 135 
Reiders Syndrome 83 
Renal Disease 182, 212 



210 



Treatment Protocols 182 
Research 21, 38, 55, 59, 105, 111, 161 

Anectodal Studies 13 

Archival Study 175 

Case Control 2, 4, 11, 23, 36, 48, 54, 73, 100 

Comparative Study 55 

Demographic Study 21, 94, 102 

Epidemiological Studies 14, 88, 108, 126 

Ethnographic Study 54, 112, 114 

Health Studies 35, 53, 63, 74 

Insulin-dependent Diabetes Study 75 

Interviewing techniques 78 

Literature Reviews 88, 137, 166 

Multidisciplinary Genetic Epidemiology Study 37 

Observational Study 115 

Personal Histories 102 

Prevalence Study 28, 59, 65, 79, 116, 148 

Prospective Study 2 

Retrospective Study 55 

Sample Survey 5 

Spanish Survey Instruments 105 

Surveys 37, 56, 85, 88, 135, 188 
Respiratory Abnormalities 59 
Respiratory Disease 60, 12 6, 166 
Respiratory Flow 12 
Respiratory Health 12 
Retrospective Survey 56 
Reye Syndrome 214 

Rheumatoid Arthritis Disease 3, 71, 83 
Risk Factors 

Cardiovascular 24, 42, 63, 64, 120, 176, 203 

Diabetes 65, 66 

High Risk Occupations 106 

Intrapartum 47 

Pesticides 82 

Pre-natal 47 
Salt 133 
Sample Survey 5 
Saturated Fat 27 
Scales 

Agression 123 

Combat Stress 13 

Dieting Behavior 67 

Family Interaction 4 

Hostility 123 

Social Readjustment 41 

Sugar Avoidance 67 
Self-esteem 50, 93 
Sere-Tek Hemaglutination Test 76 
Sex Comparisons 14, 15, 20, 137, 203 
Sex Role 20, 93, 137 
Sexual Abuse 184, 196, 209, 215 
Sickness Impact Profile 105 
Skin Color 19, 65 



211 



Smoking 36, 58, 60, 94, 120, 144, 145, 211, 216 

Social Index 46 

Social Influence 81 

Social Networks 88 

Social Support 51, 61, 81 

Social Readjustment Scale 41 

Social Workers 165 

Socialization 6 

Socio-cultural 19, 161, 185 

Sociodemographics 78 

Socioeconomic factors 68, 152, 164, 168, 181 

Socioeconomic Status 20, 30, 31, 67, 91, 94, 107, 117, 118, 

120, 140, 176, 184, 185, 189, 193, 198, 206 
Spanish Speaking 1, 10, 142, 154, 165, 218 
Spirometry 59 
Splenectomy 168 
Stool Specimen 79,155 
Streptococcus (Group B) 96 
Stress 14, 41, 51, 61, 93, 114, 191, 207 
Stroke 29, 200 
Substance Abuse 8, 98 
Suburban 19 
Sugar 67, 134 
Sugar Avoidance Scales 67 
Suicides 109 

Superoxide Dismutaise 23 
Systemic Lupus Erythematosus (LE) 182 
Taenia Solium 170 
Tecato Subculture 98 
Tests 

Michigan Alcoholism Screening Test 52 

Post Coital 2 

Sere-Tek Hemaglutination 76 

Visual Retention 157 
Texas 4, 11, 14, 18, 24, 25, 26, 27, 28, 30, 31, 32, 35, 37, 

38, 42, 43, 45, 49, 53, 64, 65, 67, 68, 69, 70, 73, 74, 

81, 88, 92, 97, 102, 103, 105, 106, 107, 111, 119, 129, 

133, 134, 135, 136, 140, 143, 145, 153, 157, 176, 183, 

184, 185, 189, 191, 197, 199, 206, 207, 208, 209, 211, 

213, 215 
Thyroid Microsomal Antibodies (TMA) 76, 130 
Triglycerides 64, 68 
Tuberculosis 10, 35, 92, 108, 128, 160, 175, 201, 204, 207 

Diagnosis 128, 201 

Drug Resistance 92 

Epidemiology 108 

Treatment 92 
Unusual Facial Appearances 178 
Uranian Miners 59 
Veterans 13 
Violence 93, 99, 113, 123, 165 

Domestic 93 
Visual Impairment 157 
Visual Retention Test 157 



212 



Vitamin 

A 7, 58, 117 

B6 118 

C 117 
WIC Program 189 
White 8, 16, 29, 41, 44, 48, 49, 55, 56, 57, 89, 91, 97, 99, 

107, 123, 126, 129, 131, 133, 134, 137, 157, 179, 217 

Non-Hispanic Whites 36 
Women Addicts 21 
Zinc 

Nutriture 7 

Supplemental 127 



213 



Title Index 



215 



TITLE INDEX 

Acculturation and domestic violence in the Hispanic 
community. 93 

Acculturation as a protective agent against diabetes in 
Mexican Americans: The San Antonio Heart Study. 119 

Alcohol abuse and parental drinking patterns among mainland 
Puerto Ricans. 6 

Alcohol consumption among Mexican American and Anglo women: 
Results of a survey along the U.S.- Mexico border. 34 

Alcohol use and abuse in ethnic minority women. 137 

Alcohol use and delinquency among Black, White, and Hispanic 
adolescent offenders. 99 

Alcoholics' transition from ward to clinic: group 
orientation improves retention. 48 

Alternative childbirth center assists Latinos. 194 

Anthropometry of Mexican American migrant children in 
Northern California. 104 

Anti-Cra: Family study and survival of chromium-labeled 
incompatible red cells in a Spanish American patient. 171 

Antituberculosis drug resistance in South Texas. 92 

El asesino silencioso: A methodology for alerting the 
Spanish-speaking community. 53 

Assessment of attitudes toward mass screening for 
colorectal cancer and polyps. 172 

Attachment interaction behavior between young teenage mothers 
and their infants. 181 

Attitudes and practices of families of children in treatment 
for cancer: A cross cultural study. 9 

Attitudes toward suicide among Mexican American and Anglo 
youth. 109 

Azarcon por empacho — another cause of lead toxicity. 84 

A la brava — frankly speaking about drug, alcohol and 



217 



substance abuse in the Chicano experience. 98 

Cancer and the Hispanic elderly. 190 

Cancer differences among Texas ethnic groups — an hypothesis. 
153 

Cancer mortality among patients with Hansen's disease. 86 

Cardiovascular disease in Mexican Americans. 63 

Cardiovascular diseases in Los Angeles, 1979-1981. 29 

Cardiovascular risk factors in Mexican Americans in Laredo, 
Texas. I. Prevalence of overweight and diabetes and 
distribution of serum lipids. 64 

Cardiovascular risk factors in Mexican Americans in Laredo, 
Texas. II. Prevalence and control of hypertension. 176 

Cerebral cysticercosis: An oversight. 147 

Cerebrospinal fluid Ige and the diagnosis of cerebral 
cysticercosis. 22 

Chicanos warned on diabetes. 205 

Child abuse. 209 

Child abuse and ethnicity: Patterns of similarities and 
differences. 139 

Child abuse and neglect among Mexican American migrants: 
A study of cases. 183 

Child abuse and neglect: The Mexican American community. Ill 

Chlamydia trachomatis is not an important cause of abnormal 
postcoital tests in ovulating patients. 2 

Cigarette smoking and lung cancer in "Hispanic" Whites and 
other Whites in New Mexico. 36 

Clinical aspects of CNS cysticercosis. 170 

Colonization of Mexican pregnant women with group B 
streptococcus . 9 6 

A comparison of the respiratory health of Mexican American 
and non Mexican American White children. 12 

Compliance with acute otitis media treatment. 164 

Congenital pernicious anemia: Report of seven patients, with 



218 



studies of the extended family. 121 

Congenital syphilis study. 210 

Congenital syphilis: Why is it still occurring? 43 

Consultation to a Puerto Rican drug abuse program. 101 

Converging and diverging beliefs about arthritis: 
Caucasian patients, Spanish speaking patients, and 
physicians. 142 

Correlates and changes over time in drug and alcohol use 
within a barrio population. 50 

County high blood pressure deaths top U. S. rate by 53%. 200 

Cuban women, sex role conflicts and the use of prescription 
drugs. 114 

Cultural and individual differences in alcohol, drug abuse, 
and mental health research. 161 

The cultural context of drinking and indigenous therapy 
for alcohol problems in three migrant Hispanic cultures. 
115 

Cultural differences and child abuse intervention with 
undocumented Spanish-speaking families in Los Angeles. 165 

Cysticercosis in California. 95 

A dangerous folk therapy. 159 

Darkly pigmented lesions in dark-skinned patients. 129 

Dealing, demoralization and addiction: Heroin in the 
Chicago Puerto Rican community. 113 

Death from cysticercosis — seven patients with recognized 
obstructive hydrocephalus. 132 

Determinants of asthma among Puerto Ricans. 166 

Diabetes: A special risk for Latinos. 2 08 

The diabetes alert study: Growth, fatness, and fat 
patterning, adolescence through adulthood in Mexican 
Americans. 45 

Diabetes alert study: Weight history and upper body obesity 
in diabetic and non-diabetic Mexican American adults. 37 

Diabetes among Mexican Americans in Starr County, Texas. 28 



219 



Diabetes and genetic admixture in Mexican Americans: The 
San Antonio Heart Study. 65 

Dietary intake of low socioeconomic Black and Hispanic 
teenage girls. 117 

Differences in socioeconomic status and acculturation among 
Mexican Americans and risk of cardiovascular disease. 120 

Does dietary health education reach only the privileged? 110 

Does ethnicity constitute a risk factor in the 
psychological distress of adolescents with cancer? 191 

Does obesity explain excess prevalence of diabetes among 
Mexican Americans? Results of the San Antonio Heart Study. 
66 

Drinking patterns and alcohol problems among Hispanics in 
Northern California. 188 

Drinking patterns and alcohol problem among Hispanics in the 
U.S. : A review. 88 

Drop in TB cases may mean hidden cases. 201 

An education program designed to prepare the Spanish-speaking 
pregnant women for the experience of fetal monitoring. 154 

Educational intervention to prevent pesticide-induced illness 
of field workers. 82 

Effect of maternal expectations and child-rearing practices 
on the development of White and Puerto Rican children. 167 



The effect of stress on maternal depression and 
acceptance/rejection of Mexican mothers. 61 

Effects of acculturation and socioeconomic status on obesity 
and glucose intolerance in Mexican American men and women. 30 

Epidemiology of alcoholism and prospects for treatment. 
151 

Ethnic and sex differences in response to clinical and 
induced pain in chronic spinal pain patients. 136 

Ethnic and social class differences in selected 
anthropometric characteristics of Mexican American and 
Anglo adults: The San Antonio Heart Study. 42 

Ethnic and social class differences related to CHD mortality 



220 



decline. The San Antonio Heart Study. 31 

Ethnic differences in health knowledge and behaviors 
related to the prevention and treatment of coronary heart 
disease: The San Antonio Heart Study. 32 

Ethnic patterns of salt purchase in Houston, Texas. 133 

Ethnicity and cancer prevention in a tri-ethnic urban 
community. 97 

Ethnicity and drinking in Northern California: A comparison 
among Whites, Blacks, and Hispanics. 89 

Ethnicity, criminality, and the Buss-Durkee hostility 
inventory. 123 

Evaluation of three potential screening tests for diabetes 
mellitus in a biethnic population. 26 

Factors relating to the increased prevalence of diabetes in 
Hispanic Americans. 177 

Familial pericentric inversion of chromosome 8. 178 

The family and child abuse in a Latino community. 152 

Family interaction and acculturation in Mexican American 
inhalant users. 4 

Folacin and iron status and hematological findings in Black 
and Spanish American adolescents from urban, low- income 
households . 1 

Gallstone size and the risk of gallbladder cancer. 11 

Genetics and epidemiology of gallbladder disease in New 
World native peoples. 73 

Getting the treatment: Recycling women addicts. 54 

Glycosylated hemoglobin determination from capillary blood 
samples utility in an epidemiologic survey of diabetes. 14 

Growth, fatness, and leaness in Mexican American children. 74 

Halothane hepatitis in three pairs of closely related 
women. 122 

Hansen's disease in Hispanic patients. 116 

Health needs of the Hispanic elderly. 141 

Health status and service utilization of Hispanic patients 



221 



with arthritis. 131 

Heart Disease tied to poverty. 193 

Heart, stroke death rates found to vary. 202 

Hemoglobin Korle BU in a Mexican family. 124 

Heroin use in the barrio: Solving the problem of relapse or 
keeping the tecato gusano asleep. 38 

HHS demonstration projects for hypertension control focus on 
Blacks and Hispanics. 180 

Hispanic drinking patterns in Northen California. 5 

Hispanic mothers less likely to smoke. 211 

Histocompatibility antigens and immunoglobin G insulin 
antibodies in Mexican American insulin-dependent diabetic 
patients. 75 

HLA antigen frequencies in cirrhotic and noncirrhotic male 
alcoholics: A controlled study. 52 

HLA phenotypes in Mexican Americans with tuberculosis. 10 

HLA typing in non-Hodgkins lymphomas: Comparative study in 
Caucasoids, Mexican Americans and Negroids. 72 

HLA-DR4 and rheumatoid arthritis in Mexican mestizos. 3 

HLA-DR4 in Negro and Mexican rheumatoid arthritis patients. 
71 

Homo diabeticus Rio Grande: Epidemiology in Starr County, 
Texas. 70 

Idiopathic fatty liver of pregnancy: Findings in ten cases. 
158 

Immunogenetic studies of juvenile dermatomyositis HLA-DR 
antigen frequencies. 16 

The immunology of cerebral cysticerosis. 148 

Impact of diabetes upon depression among Mexican Americans. 
46 

The impact of kin, friend and neighbor networks on infant 
feeding practices. Cuban, Puerto Rican and Anglo families in 
Florida. 87 

Incidence of biliary tract cancer in Los Angeles. 44 



222 



Incidence of breast-feeding in a low socioeconomic group of 
mothers in the United States: Ethnic patterns. 162 

Information preferences of cancer patients ages 11-20 years. 
138 

Ingredients in nutrition education: Family involvement, 
reading and race. 179 

Intestinal parasites among Indochinese refugees and Mexican 
immigrants resettled in Contra Costa County California. 79 

Intracultural variation in attitude and behavior related to 
alcohol: Mexican Americans in California. 112 

Knowledge, attitudes, and behavior related to obesity and 
dieting in Mexican Americans and Anglos: The San Antonio 
Heart Study. 67 

Latino play on sexual abuse moves community. 196 

Lead poisoning from Mexican folk remedies-California. 173 

Low vitamin A and zinc concentrations in Mexican American 
migrant children with growth retardation. 7 

Lung cancer risk and vitamin A consumption in New Mexico. 58 

Lupus nephritis in Black and Hispanic children. 182 

Malignant melanomas of the skin diagnosed and treated in 
Albuquerque, New Mexico in 1980. 163 

Maternal touch at the 1st contact with the newborn infant. 
185 

Measles outbreak - New York City. 174 

Medicine at a glance. 199 

Mexican American heroin addicts. 102 

The Mexican American with non-insulin dependent diabetes 
mellitus - an epidemiological report. 140 

Mexican Americans and diabetes. 212 

MMPI differences of male Hispanic American, Black, and White 
heroin addicts. 49 

A new immunology test for cysticercosis. 149 

Nutrition monitoring and research in the Department of 



223 



Health and Human Services. 85 

A nutrition profile of the Hispanic elderly. 77 

Occupation health hazards faced by Hispanic workers: An 
exploratory discussion. 106 

Opioid use in San Antonio. 143 

Pancreatic islet cell and thyroid antibodies, and islet cell 
function in diabetic patients of Mexican American origin. 
76 

Pedal morbidity in rheumatic diseases: A clinical study. 83 

Pediatric blood pressure: Ethnic comparisons in a primary 
care center. 25 

Phencyclidine in an East Harlem psychiatric population. 91 

Pitfalls in measuring the health status of Mexican Americans: 
Comparative validity of the English and Spanish Sickness 
Impact Profile. 105 

Post - traumatic stress disorder in Hispanic Vietnam veterans 
- clinical phenomenology and sociocultural characteristics. 
13 

Poverty kills, new heart study finds. 203 

Prenatal care and infant outcome in Mexican women. 47 

Prevalence of clinical gallbladder disease in Mexican 
American, Anglo and Black women. 107 

Prevalence of diabetes in Mexican Americans: Relationship to 
percent of gene pool derived from Native American sources. 
18 

Prevalence of growth stunting and obesity: Pediatric 
nutrition surveillance system, 1982. 186 

The prevalence of intestinal parasites in Puerto Rican farm 
workers in Western Massachusetts. 155 

Prevalence survey of respiratory abnormalities in New Mexico 
uraniunm miners. 59 

The prevention and treatment of child abuse and neglect: A 
focus on the Mexican American family. 184 

Primary dental arch characteristics of Mexican American 
children. 80 



224 



Puerto Ricans have high asthma rate study concludes. 213 

Quality of maternity care in rural Texas. 40 

Racial patterns of alcoholic beverage use. 39 

Rape. 195 

Recent trends in tuberculosis in children. 160 

Rehabilitation of the Puerto Rican addict: A cultural 
perspective. 135 

The relationship between levels of information about uterine 
cancer and pap smear usage in low-income Hispanic 
population. 33 

The relationship between vitamin B-6 levels in the diet and 
breast milk of ten Mexican American women. 118 

Religious programs and careers of chronic heroin users. 103 

Research issues 31: Women and drugs. 21 

Respiratory disease in a New Mexico population sample of 
Hispanic and non-Hispanic Whites. 60 

Reye Syndrome. 214 

Risk factors for coronary heart disease in Hispanic 
population: A review. 94 

San Antonio heart study compares ethnic groups. 24 

Saturated fat and cholesterol avoidance by Mexican American 
and Anglos: The San Antonio Heart Study. 27 

Selected maternal-infant care practices of Spanish speaking 
women. 192 

Self -reported intoxication among Hispanics in Northern 
California. 90 

Sex differences in the effects of sociocultural status on 
diabetes and cardiovascular risk factors in Mexican 
Americans: The San Antonio Heart Study. 68 

Sex roles among deviants: The woman addict. 55 

Sexual Abuse. 215 

Smoking. 216 

Smoking and depression: A community survey. 15 



225 



Smoking behavior among Hispanics: A preliminary report. 144 

Smoking behavior among U. S. Latinos: An emerging 
challenge for public health. 145 

Social epidemiological factors underlying contrasts in 
Mexican American and Anglo American blue-and-white collar 
drinking patterns. 20 

Social support, social influence, ethnicity, and the 
breastfeeding decision. 81 

Sociocultural and genetic influence on plasma glucose: A 
comparison of Mexican Americans and Anglos in San Antonio. 19 

Spectrum of amebiasis in children. 146 

Spontaneous radiographic disappearance of cerebral 
cysticerosis: Three cases. 150 

Staff awareness of Hispanic health beliefs that affect 
patient compliance with cancer treatment. 78 

Stress and coping as determinants of adaptation to pregnancy 
in Hispanic women. 51 

Stressful life events, psychological symptoms, and 
psychological adjustment in Anglo, Black, and Cuban 
elderly. 41 

A study of professed reasons for beginning and 
continuing heroin use. 17 

A study of the attitudes toward child abuse and child rearing 
among Mexican American migrants in Texas. 69 

Study shows Hispanics have greater diabetes risk. 197 

Successful home hemodialysis in purportedly unacceptable 
patients. 100 

Summary of market research for "Healthy Mothers, Healthy 
Babies" campaign. 189 

Supermarket sales of high-sugar products in predominantly 
Black, Hispanic, and White census tracts of Houston, Texas. 
134 

Superoxide dismutase levels of E. coli isolated in diabetes 
gangrene. 23 

Survey research in New Mexico Hispanics: Some methodological 
issues. 126 



226 



Survival of cadaveric renal allografts in Hispanic as 
compared with Caucasian recipients. 168 

Thirty years after isoniazid: Its impact on tuberculosis in 
children and adolescents. 35 

Thyroid autoimmunity in Type II (non-insulin-dependent) 
diabetic patients of Caucasoid, Black and Mexican origin. 130 

TB rate among Southeast Asians, Latinos in U.S. higher than 
average. 204 

Treatment program clients and emergency room patients: A 
comparison of two drug-using samples. 8 

Tuberculosis among Hispanics in the United States-1980. 175 

Tuberculosis in the Chicano communities of Los Angeles: Is 
there an epidemic? What is being done about it? 108 

Tuberculosis screening: Evaluation of a food handlers 
program. 128 

T.V. proves successful in reaching Spanish Speaking. 217 

Ultrasonographically observed early placental maturation and 
perinatal outcome. 156 

Use of lead tetroxide as a folk remedy for gastrointestinal 
illness. 62 

Utilization of alcoholism services by Mexican Americans: A 
case study in social networks and ethnic marginal ity. 125 

Validity of the Spanish surname infant mortality rate as a 
health status indicator for the Mexican American 
population. 169 

Visual memory of male Hispanic American heroin addict. 157 

When drugs come into the picture, love flies out the window: 
Women addicts' love relationships. 56 

Why asthma hits some minorities hardest. 198 

Women addicts' experience of the heroin world: Risk chaos and 
innundat ion . 5 7 

Women's cancer screening and prevention project final report. 
187 

Women's health: A Hispanic perspective. 207 



227 



Women's health: A Latina perspective. 206 

Zinc supplementation during pregnancy: Effects on selected 
blood constituents and on progress and outcome of pregnancy 
in low-income women of Mexican descent. 127 



228 



II i~k M 



Q" List 



229 



"Q" LIST 
APPENDIX FOR QUESTIONNING RESEARCHERS 



AUTHOR: 
TITLE : 

SOURCE: 



AUTHOR: 
TITLE: 



AUTHOR: 
TITLE : 



SOURCE : 



What do we know 



Andrade, S. J. (1981, April) . 

Contraceptive use by adolescents: 

about Chicanas? 

Paper presented in the Symposium "Passages a la 

Mexicana", at the annual meeting of the American 

Educational Research Association, Los Angeles, CA. 



Ansari, R. & Scheiderman, L. J. (1982) . 
Ethnic group response to preventive 
education. 



health 



SOURCE: Urban Health. 11(6) , 335-348. 



AUTHOR: Chin, D.M. (1985) . 

TITLE: Telephone contacts for data users. (No. 4) . 
SOURCE: Washington, DC: U.S. Department of Commerce, Bureau 
of the Census, Data User Services Division. 



Coe, M. F. (1983) . 
Factors affecting choice 



process of medical care 



utilization in a Latino minority' s dual use: La 
Clinica de la Raza and Kaiser 

Ann Arbor, MI: University Microfilms International 
No. 8413288. 



AUTHOR: 
TITLE: 

SOURCE : 

AUTHOR: 
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TITLE : 



SOURCE : 



AUTHOR : 

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AUTHOR: 

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SOURCE : 



Comas-Diaz, L. (1981). 

Ethnicity and treatment — Puerto Rican espiritismo 

and psychotherapy. 

American Journal of Orthopsychiatry , 51(4) , 636-645. 

Cuellar, J. B. & Sanford, E. P. (1983) . 

A guide to minority aging references (DHHS 

Publication No. OHDS 83-209141). 

Washington, DC: U.S. Government Printing Office. 

Gumming, G. R. (1980) . 

What will be the picture of hospital services for 
1990? Recommendations for California health 
facilities commission goals and program 1980-1990. 
California Health Facilities Commission, 555 Capitol 
Mall, Sacramento, CA 95814. 

Curren, D. J. (Ed.). (1985, March). 

The COSSMHO Reporter, 10(1) . 

Available from the COSSMHO National Office, 1030 

15th Street NW, Suite 1053, Washington, DC 20005. 



Curren, D. J. & Soler, R. (Eds.) 
The COSSMHO Reporter, 8(1) . 
Available from the COSSMHO National 



(1982, April/May) . 
Office, 1030 



231 



15th Street NW, Suite 1053, Washington, DC 20005, 



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CURREN, D. J. (Ed.)- (1978). 

Hispanic Report on families and youth . 

Available from the COSSMHO National Office, 103 

15th Street NW, Suite 1053, Washington, DC 20005. 

Delgado, M. (1983) . 

Hispanic natural support systems: Implications for 

mental health services. 

Journal of Psychosocial Nursing and Mental Health 

Services, 21(4), 19-24. 



AUTHOR: 
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Delgado, M. & Delgado, D. (1982) . 
Natural support systems: source 
Hispanic communities. 
Social Work, 27, 83-90 



of strength in 



Elizondo, E. T. (1980) . 

38th annual meeting (abstracts) . 

Available from the United States/Mexico Border 

Health Association. 606 N.Mesa, Suite 700, El Paso, 

Texas 79912. 



AUTHOR: Ezzati, T. M. & Massey, J. T. (1980, October) . 
TITLE: Sample design issues for the Hispanic health and 

nutrition examination survey . 
SOURCE: Paper presented at the meeting of the American 

Public Health Association, Detroit, MI . 

AUTHOR: Foster, G. M. (1981) . 

TITLE: Relationship between Spanish and Spanish American 

folk medicine. 
SOURCE: Transcultural Health Care. Addison-Wesley Press. 



AUTHOR: Griffith, S. (1982). 

TITLE: Childbearing and concept of culture. 

SOURCE: Journal of Obstretics, Gynecologic and 
Nursing, 11(3), 181-184. 

AUTHOR: Guerra, F. A. (1980). 

TITLE: Hispanic child health issues. 

SOURCE: Children Today, 9(5) 18-22. 



Neonatal 



AUTHOR: Hall, W. T. , St. Denis, G. C. , & Young, C. L. (Eds.). 
TITLE: The family: A critical factor in prevention" . 

(Grant No. MCJ-00014-25) . 
SOURCE: University of Pittsburg. Graduate School of Public 

Health. 



AUTHOR: Hardwood, A. (Ed.). 

TITLE: Mainland Puerto Ricans. 

SOURCE In Ethnicity and Medical Care, 



MA: 



Harvard 



232 



University Press, 



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Health Resources and Services Administration. (1984) 
Minorities and women in the health fields 
(DHHS Publication No.HRSA HRS-DV 84-5) . 
Washington, DC: U. S. Government Printing Office. 



Islas, Inc., (Ed.). (1983) 
Hispanic and health research in 



the Public Health 



Service: Public health research issues. 



Rockville, MD: U.S. Department of Health and Human 
Services. Public Health Service (Hispanic Employees 
Organization) . 

Islas, Inc., (Ed.). (1984). 

Hispanic women ' s health issues. 

Rockville, MD: U.S. Department of Health and Human 

Services. Public Health Service (Hispanic Employees 

Organization) . 

Keefe, S. M, (1982) . 
Native-born Mexican Americans. 
Social Science and Medicine, 16 , 1467. 

Kennedy, C. G. (1982) . 

Descriptive study of factors influencing the level 
of self-health assessment and health-illness 
behaviors of the Mexican American elderly. 



Unpublished 
University, 



master 1 s 
Los Angeles. 



thesis. 



California State 



AUTHOR: Kenton, C. (1982). 

TITLE: Health needs and services for Hispanic Americans: 

January 1980-July 1982. 
SOURCE Literature Search Program, Reference Section, 

National Library of Medicine, 8600 Rockville Pike, 

Bethesda, MD 20209. 

AUTHOR: Lefkowitz, B. , & Andrulis, D. (1981). 

TITLE: Better health for our children: A national strategy. 

(DHHS Publication No. 79-55071) . 
SOURCE: Washington, DC: U.S. Government Printing Office. 

AUTHOR: Lopez -Aqueres, W. , Kemp, B. , Staples. F. , & Brummel- 

Smith, K. (1984) . 
Title: Use of health care services by older Hispanics. 
SOURCE: Journal of the American Geriatrics Society, 32(6) , 

435-440. 

AUTHOR: Marin, B. V., Marin, G. , Padilla, A. M. , de la 

Rocha, C. & Fay, J., (1981). 
TITLE: Health care utilization by low-income clients of a 

community clinic: An archival study, (occasional 



233 



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paper No. 12) . 

University of California, Los Angeles. 

Speaking Mental Health Research Center. 



Spanish 




Markides, K. S. (1983). 

Mortality among minority populations: A review of 

recent patterns and trends. 

Public Health Reports , 98(3) , 252-260. 

Martinez, R. A. (Ed.). (1979). 

Hispanic culture and health care: Fact, fiction, 

folklore. 

St. Louis: C. V. Mosby Co. 

Mirowsky, J., & Ross, C. E. (1984). 

Mexican culture and its emotional contradictions 

Journal of Health and Social Behavior, 25 , 2-13. 

Montiel, M. (Ed.). (1978). 

Hispanic families: Critical issues for policy and 

programs in human services. 

Available from the COSSMHO National Office. 103 

15th Street NW, Suite 1053, Washington, DC 20005. 

Mull, J. D., & Mull, D. S. (1981). 

Residents' awareness of folk medicine beliefs o f 

their Mexican patients. 

Journal of Medicine, 56 (6) , 5 20-522. 

Murillo-Rhode, I. (1981). 
Hispanic American patient care . 
Transcultural Health Care. Addison Wesley. 

Nathanson, D. (1980) . 

Ambient lead concentrations in New York City and 

their health implications. 

Bulletin of the New York Academy of Medicine, 56 (9) . 

National Center of Health Statistics. (1981) . 

The Hispanic health and nutrition examination: 

survey : Fact sheet (DHHS Publication No. PHS 82 

-1287) . 

Washington, DC: U. S. Government Printing Office. 

Poma, P. A. (1983) . 

Hispanic cultural influences on medical practice. 
The Journal of the American Medical Association, 75 
(10), 941-946. 

Roberts, R. E. & Lee, E. S. (1980) . 

The health of Mexican Americans: Evidence from the 

human population of laboratory studies. 

American Journal of Public Health, 70(4) , 375-384. 



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Rodriquez, J. (1983) . 

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practices. 

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Factors influencing health 



Rodriquez, S. S., & R. M. Rodriguez (Eds). (1982) 
The new federalism: Impact on Hispanic health care. 
Public health policy issues. 

Rockville, MD: U. S. Department of Health and Human 
Services. Public Health Service. ( Hispanic 
Employees Organization) . 



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Sahadi, J. A. (1980) . 

Pseudoexfoliation syndrome 

Texas. 

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encountered in South 



Sanchez, A. L. (1983) . 

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health beliefs and health seeking behaviors of 

Hispanic elderly. 

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No. 8319453. 



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Schmidt, A. (1982) . 
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interaction in 
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AUTHOR: Staff (1983/Summer) . 

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SOURCE: University of California, Los 

Speaking Mental Health Research 

Bulletin. 



Angeles, Spanish 
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AUTHOR: Staff (1984). 

TITLE: Hispanic mental health bibliography. Folk medicine/ 

curanderismo/espiritismo . 
SOURCE: Unniversity of Calilfornia, Los Angeles. Spanish 

Speaking Mental Health Research Center. 

AUTHOR: Staff (1984, November). 



235 



TITLE: Latino health study. 
SOURCE: Nuestro. p. 12. 

AUTHOR: Sullivan, T. A., Gillespie, F. P., Hout, M. & 

Rogers, R. G. (1984) . 
TITLE: Alternative estimates of Mexican American 

mortality in Texas, 1980. 
SOURCE: Social Science Quarterly , pp. 609-617. 

AUTHOR: Torres-Gil, F. (1979). 

TITLE: Health issues in the Chicano community: Some 
preliminary findings on older Chicanos and 
decisionmakers ' perceptions of health problems. 

SOURCE: University of Southern California, Los Angeles. 
Andrus Gerontology Center. 



AUTHOR: 
TITLE: 

SOURCE : 

AUTHOR: 
TITLE: 

SOURCE : 



Trevino, F. M. & Moss, A. J. (1984) . 

Health indicators for Hispanic, Black, and White 
Americans (DHHS Publication No. PHS 84-1576) . 
Washington, DC: U.S. Government Printing Office. 

Trevino, F. M. (1982) . 

Vital and health statistics for the U.S. Hispanic 

population. 

American Journal of Public Health, 72_ (Sept) , 979- 

981. 



AUTHOR: 
TITLE: 

SOURCE : 

AUTHOR: 
TITLE: 



SOURCE : 



Trotter II, R. T. (1981). 

Folk remedies as indicators of common illnesses: 
Examples from the United States Mexico border. 
Journal of Ethnopharmacology , 4, 207-221. 

Unterman, R. D. W. (1983) . 

Folk health beliefs, health/ illness needs and 

concerns, and personal health behavior of the 

Hispanic adolescent. 

Ann Arbor, MI: University Microfilms International 

No. 132112. 



AUTHOR: 
TITLE : 

SOURCE : 



AUTHOR: 
TITLE: 

SOURCE : 



AUTHOR: 



Vivo, P (Ed.) . (1980) . 
La familia Hispana: 



The United States 



health 



perspective . 

Rockville, MD: U. S. Department of Health and Human 
Services, Public Health Service, (Spanish Heritage 
Public Health Service Workers) . 

Vivo, P. & C. D.Votaw (Eds.). (1981). 

The Hispanic elderly: La fuente de nuestra historia, 

cultura y_ carino. 

Rockville MD: U. S. Department of Health and Human 

Services, Public Health Service, (Spanish Heritage 

Public Health Service Workers) . 

Vivo, P. (Ed.) . (1978) . 



236 



TITLE : 
SOURCE : 



AUTHOR: 
TITLE: 

SOURCE : 



AUTHOR: 
TITLE : 

SOURCE : 



Hispanic Mosaic: 
perspective. 
Rockville, MD: U.S 
Services, 



Public Health Service 



Department of Health and Human 
Public Health Service, (Spanish Heritage 
Public Health Service Workers) . 



Vivo, P. (Ed.) . (1979) . 

International year of the child: 

Hispanic health perspective. 

Rockville, MD: U.S. Department of Health 

and Welfare, Public Health Service, 

Heritage Public Health Service Workers) . 



The United States 



Education 
(Spanish 



Wallace, H. M. , & Polhemus, D. (Eds.). (1981). 
Proceedings in the BiRegional conference on health 
status and health care of mothers and children. 
San Diego State 
Public Health. 



University. Graduate School of 



AUTHOR: Watts, M. S. M. (Ed.). (1983). 

TITLE: Cross-cultural medicine. 

SOURCE: The Western Journal of Medicine, 139 (6) . 

AUTHOR: Zaldivar, C. A., Nichols, A. W. , Gonzales, H. P., & 

Kelly, J. B. (1985) . 
TITLE: Border health . 
SOURCE: Available from United States- Mexico Border Health 

Association, 6006 N. Mesa, Suite 700, El Paso, Texas 

79912. 



237 



ACKNOWLEDGEMENTS 

The task of putting together this bibliography would 
not have been possible, nor would it have been such a stimu- 
lating and exciting activity, if it had not been for the 
remarkable skill and dedication of a large number of 
people. Special recognition must be given to the efforts 
of the professionals who responded to the nationwide 
requests for help by willingly giving their time, energy and 
knowledge, unselfishly sharing copies of documents, manu- 
scripts, reprints, bibliographies and dissertations both 
published and unpublished. Their cooperation made it possi- 
ble to complete this mammoth task in the short time allotted. 

Without the guidance, assistance and support of Dr. 
Marta Sotomayor of the Department of Health and Human Ser- 
vices there would be no bibliography — she has earned a very 
special thanks. 

Recognition and gratitude are extended to the advisory 
board, whose efforts supported the project. Special recogni- 
tion must be given to those who assisted in expanding the 
collection of the material: Susana P. Juarez, Texas Tech 
University Health Science Center, Lubbock, Texas, School of 
Nursing; Faustina Ramirez Knolls for getting Rick Martinez 
of the Bexar County Hospital District to share his comprehen- 
sive and current bibliography; Dr. David Boubion, John Le 
Valley, M.D., and Cornelia Bayloch of California State Uni- 
versity, Los Angeles; Juanita Kuhlmann for discovering and 
introducing Ann Robertson of the Fresno Community Hospital 
Medical Library, whose collection of materials on Hispanic 
health issues was one of the most current and who provided 
an excellent ambience in which to work; and to Dr. Joyce 
Elmore, Aileen Schlef, Esther Coto Walloch, and Estela Lomeli 
for their encouragement and support early in the project when 
I needed it most. 

Acknowledgments and thanks must also be extended to the 
abstractors who took time from their busy schedules to pre- 
pare the abstracts which are the main body of this work: Dr. 
David Hayes Bautista, University of California at 
Berkeley; Dr. Amado Padilla, University of California at 
Los Angeles, and Dr. Mary Lou de Leon Siantz, University of 
Indiana; research assistants Lucille Roybal Allard and 
Christina Ann Villaescusa, who diligently searched for 



238 



articles that would be appropriate to the scope of the pro- 
ject; proof readers Karen Abell, Kevin Deady, and 
Rebecca Villaescusa; Richard Chabran, whose library science 
skills were most helpful; Munson & White and Faye Stabler, 
who allowed us to present a professional-looking document; 
and Marion E. Graff, whose outstanding business management 
skills kept things running smoothly. 

Special thanks go to Lourdes Baezcone-Garbanati, staff 
research assistant of the Spanish-Speaking Mental Health 
Research Center, University of California at Los Angeles, who 
took time from her busy day and in a warm, friendly manner 
offered her invaluable knowledge and encouragement. 

Finally, a grateful acknowledgment to my parents, Luis 

and Josie Villaescusa, whose unfailing good humor and 

patience have been most valuable to all who worked on this 
project. 



Henrietta Villaescusa 
Project Director 



The preparation of this bibliography was made possible under 
purchase orders No. 263-MD-507218 and 263-MD50622. The views 
and recommendations included in this document however, do 
not necessarily represent the views of any agency of the 
United States government. 



239 



Inventory of DHHS 
Program Efforts in Minority 
Health 




INVENTORY OF DHHS PROGRAM EFFORTS IN MINORITY HEALTH 



The inventory of program efforts in minority health was compiled 
in response to the Secretary's charge to review existing department 
research and services programs and activities which focus or have impact 
on minority health. It provides a comprehensive description of all 
programs, current or planned, within the Department of Health and Human 
Services that relate specifically to minority populations. The information 
was used by the Task Force in their recommendation development process 
to ensure that the suggested activities would provide new directions to 
already existing Departmental initiatives. The inventory also will 
be informative to organizations and individuals actively involved with 
minority health issues. 

Program information was obtained from 11 agencies or departmental 
components : 

Alcohol, Drug Abuse, and Mental Health Administration 

Centers for Disease Control 

Food and Drug Administration 

Health Care Financing Administration 

Health Resources and Services Administration 

National Institutes of Health 

Office of the Assistant Secretary for Health 

Office for Civil Rights 

Office of the Secretary 

Office of Human Development Services 

Social Security Administration 

The program descriptions were based on data maintained in each 
agency's data management system; they varied greatly in the amount of 
detail provided. Although the inventory originally was intended to identify 
programs that focused specifically on minority populations, it was found that 
many programs benefited all popualtions including minorities. In some 
instances, it was possible to identify the extent of activities targeted 
to minorities, for others, it was difficult to separate minority- 
specific components from the overall program. It is important to note 
that this compilation of DHHS programs and projects represents the 
first attempt by DHHS to group departmental activities in the area of 
minority health and should be viewed as a starting point for future 
data gathering and analysis. 

Questionnaire Development 

A four-page questionnaire was developed requesting program-level 
officers to indicate whether their programs addressed the following 
areas: cancer; cardiovascular and cerebrovascular disease; diabetes; 
arthritis and other musculoskeletal disorders; nutrition; diseases and 
disorders of the eye; infectious diseases; digestive disorders; genetic 



243 



disorders; infant mortality and maternal health; homicide, suicide, and 
unintentional injuries; chemical dependency and related diseases; 
mental health and illness; occupational health; respiratory diseases; 
dental health; kidney disorders; or some other disorder. 

Another series of questions requested descriptions of programs 
and how each program addressed minority health issues. The major 
classes of activity were: health service delivery, research and data 
collection, health professions development, and health education/ 
information dissemination. Overall, the questionnaire attempted to 
gauge the extent of existing DHHS programs that addressed minority 
health concerns. 

Data Collection 

Inventory questionnaires were distributed to the 4 major components 
of DHHS: the Assistant Secretary for Health, the Assistant Secretary for 
Human Development Services, the Administrator of the Health Care Financing 
Administration, and the Commissioner of the Social Security Administration, 
who in turn distributed them to their respective operating divisions. 
Instructions were provided that explained the purpose of the survey and 
the required information. Meetings were held with liaison persons from 
each agency to explain the nature of the Task Force and answer questions. 
More than 195 responses were returned by the agencies. 

Data Reporting 

The program descriptions reflect the broad diversity of the programs 
administered by DHHS. Although some submissions focus on broad research 
issues which, by their very nature, included minority health issues, 
others focus on model demonstration programs that target specific 
minority groups. To preserve the richness of the descriptions, no 
attempt was made to combine the material into broader classifications. 

Index of DHHS Programs 

The index lists the agencies or institutional components that have 
ongoing or planned minority-related initiatives. More complete program 
descriptions follow and are organized according to sponsoring agency or 
other departmental component. The office/program title and phone 
number are included so future users may readily obtain additional 
information. 



244 



INDEX TO INVENTORY OF DHHS PROGRAM EFFORTS IN MINORITY HEALTH 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 251 

National Institute of Alcohol Abuse and Alcoholism 251 

Division of Biometry and Epidemiology 

Black and Hispanic Alcohol Problems: A National Study 

National Institute on Drug Abuse 253 

National Drug Abuse Media Campaign 

Ethnic Community Initiative 

NIDA Starter Award 

Minority Access to Research Centers 

Prevention of Drug Abuse Among Minority Populations 

Treatment of Drug Abuse Among Minority Populations 

Ethnic Minority Family Mobilization Project 

Estimating Mental Health Need 

National Institute of Mental Health 259 

Prevention Program 

Center for Studies of Mental Health of the Aging 

Center for Studies of Minority Group Mental Health 

Center for Studies of Antisocial and Violent Behavior 

Center for Prevention Research 

Center for Mental Health Studies of Emergencies 

Center for Epidemiologic Studies 

Mental Health Clinical Research Centers 

Research Scientist Development 

NIMH Minority Biomedical Research Support 

Clinical Research Branch 

Small Grant Program 

Psychosocial Treatments Research 

Child and Adolescent Service System Program 

Community Support Program 

National Research Service Award 

Mental Health Clinical Training 

National Reporting Program 



CENTERS FOR DISEASE CONTROL 277 

Investigations and Technical Assistance 

Injury Prevention 

Childhood Immunization Grants 

Occupational Safety and Health - Research Grants 

Occupational Safety and Health - Training Grants 

Health Programs for Refugees 

Venereal Disease Control Grants 

Venereal Disease Research, Demonstration, and Public 

Information & Education Grants 
Project Grants and Cooperative Agreements for Tuberculosis 

Control Programs 
Cooperative Agreements for State-Based Diabetes Control Programs 
Violence Epidemiology Branch 



245 



FOOD AND DRUG ADMINISTRATION 285 

Center for Food Safety and Applied Nutrition 
Task Force to Increase Interaction with Minority 

Health Professional Schools 
Office of Consumer Affairs 
Communications 
Consumer Affairs Education Program (Field Offices) 



HEALTH CARE FINANCING ADMINISTRATION 290 

Medicare 

End-Stage Renal Disease Program 

Medicaid 

Research and Demonstration 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 294 

Indian Health Service 

Community Health Centers 

Black Lung Clinics 

Migrant Health Program 

Home Health Services 

National Health Service Corps 

National Health Service Corps Scholarship Program 

Hansen's Disease Program 

Health Careers Opportunity Program 

Advanced Financial Distress 

Nursing Special Project Grants 

Professional Nurse Traineeship Grant Program 

Area Health Education Centers 

Health Professions Analytical Studies and Reports 

Nurse Midwifery Office 

Contract Health Service 



NATIONAL INSTITUTES OF HEALTH 309 

Division of Research Resources 309 

Animal Resources Program 
Biomedical Research Support Program 
General Clinical Research Centers Program 
Biomedical Research Technology Program 
Minority Access to Research Careers Program 
Minority Biomedical Research Support Program 



246 



National Cancer Institute 315 

Epidemiology Research Program 

Chemical and Physical Carcinogenesis Research Program 

Biological Carcinogenesis Research Program 

Nutrition Research Program 

Tumor Biology Research Program 

Immunology Research Program 

Diagnostic Research Program 

Preclinical Treatment Research Program 

Clinical Treatment Research Program 

Rehabilitation Research Program 

Comprehensive Minority Biomedical Program 

Cancer Control Program 

National Eye Institute 321 

Retinal and Choroidal Diseases Branch 
Strabismus, Amblyopia, and Visual Processing 
Intramural Research Program 
Anterior Segment Diseases Branch 

National Heart, Lung, and Blood Institute 323 

Heart and Vascular Diseases Program 

Epidemiology and Biometry Program 

Lung Diseases Program 

Blood Diseases and Resources Program 

Companion Issues 

Office of Prevention, Education, and Control 

National Institute on Aging 329 

Behavioral Sciences Research 

Systolic Hypertension in the Elderly 

Public Information Office 

Epidemiology, Demography, and Biometry Program 

Gerontology Research Program 

National Institute of Allergy and Infectious Diseases 332 

Microbiology and Infectious Diseases Program 
Immunology, Allergic and Immunologic Diseases Program 

National Institute of Arthritis, Diabetes, and Digestive 

and Kidney Diseases 334 

Arthritis, Musculoskeletal and Skin Diseases 

Diabetes 

Digestive Diseases and Nutrition 

Kidney, Urologic, and Hematologic Diseases 

Pima Indian Studies 

National Institute of Child Health and Human Development .... 338 
Center for Research for Mothers and Children 
Healthy Mothers, Healthy Babies Program 
Center for Population Research 
Intramural Activities 



247 



National Institute of Dental Research 345 

Office of the Director 
Extramural Programs 

National Institute on Neurological and Communicative Disorders . . 347 
Travel Fellowships for Minority Neuroscientists 
Survey of Major Neurological Disorders in Copiah County, 

Mississippi 
Chronic CNS Disease Studies: Slow, Latent and Temperate Virus 

Infection 
Summer Research Fellowship Program 

National Institute of General Medical Sciences ....... 349 

Pharmacological Sciences Program 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 350 

National Center for Health Statistics 350 

National Hospital Discharge Survey 

NHANES I Epidemiologic Follow-up Survey: Continued Follow-up 1985-86 

National Medical Care Utilization and Expenditure Survey 

National Ambulatory Medical Care Survey 

National Nursing Home Survey 

National Master Facility Inventory 

National Health and Nutrition Examination Survey 

Hispanic Health and Nutrition Examination Survey 

Vital Statistics Follow-back Survey Program 

National Vital Statistics Program 

National Survey of Family Growth 

National Health Interview Survey 

Office of Public Affairs 357 

Healthy Mothers, Healthy Babies Coalition 

Information and Education on Acquired Immune Deficiency Syndrome 

Office of Disease Prevention and Health Promotion 359 

National Health Promotion Program 
National Health Information Clearinghouse 
1990 Objectives for the Nation Initiative 
U.S. Task Force on Preventive Services 

Office of Refugee Health 363 

Refugee Preventive Health 
Cuban/Haitian Entrant Program 
Health Program for Refugees 

Office of Population Affairs 366 

Adolescent Family Life 
Family Planning Program 



248 



Office of Health Planning and Evaluation 368 

Inventory of DHHS Activities Concerned with Infant 
Mortality and Low Birthweight 



OFFICE OF THE ASSISTANT SECRETARY FOR HUMAN DEVELOPMENT SERVICES . 369 

Administration for Native Americans 

Administration on Developmental Disabilities 

Administration for Children, Youth, and Families (Head Start) 

Coordinated Discretionary Funds Program 

Administration on Aging 
Gerontology Training 

Title III, Older Americans Act, Part B: Nutrition Services 
Title IV, Older Americans Act, Grants to Indian Tribes for Supportive 
and Nutrition Services 



OFFICE OF THE SECRETARY 376 

Assistant Secretary for Planning and Evaluation 
Office for Civil Rights 

SOCIAL SECURITY ADMINISTRATION 378 

Health-Related Program 



249 



250 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: DIVISION OF BIOMETRY AND EPIDEMIOLOGY (DBE) /NATIONAL INSTITUTE ON 
ALCOHOL ABUSE AND ALCOHOLISM (NIAAA) 

TELEPHONE: 301-443-4897 

DESCRIPTION: 

Major studies include: 

• A cross-sectional survey of approximately 1,000 Black and non-Black 
youth 16 to 26 years of age in Baton Rouge, Louisiana. The purpose of 
the study is to investigate the nature, antecedents, and short-term 
consequences of drinking in this population. Information to be obtained 
includes drinking history and patterns of access to alcohol and other 
illicit drugs, the extent of polydrug use, demographic characteristics, 
social networks and social activity level. 

• A longitudinal study of approximately 13,000 young adults, initiated in 
1979. The design called for a cross-sectional sample of youth 14 to 21 
years of age in 1979, with supplemental samples of Blacks, Hispanics, 
and economically disadvantaged non-Black, non-Hispanic youth. The 
purpose of the longitudinal study is to assess changes in the prevalence 
of drinking and alcohol abuse over time and to relate alcohol use to 
employment status including aspects of work which precipitate heavy 
drinking, unemployment, and whether women experiencing dual role stress 

( employee /homemaker) are at higher risk for alcohol abuse. Preliminary 
findings of the 1982 data reveal higher levels of alcohol abstinence 
among both minority groups (Black and Hispanic) and a later onset of 
drinking among Blacks compared to Hispanics and other non-Black youth. 

• A cross-sectional survey of approximately 1,000 Americans of Japanese 
ancestry living in Hawaii and in California. The survey will be 
coordinated with studies of the Japanese population residing in four 
communities in Japan. The primary purpose of this collaborative 
epidemiological research effort by the U.S. and Japan is to conduct 
descriptive baseline studies of cross-cultural differences in alcohol 
consumption and drinking patterns, alcohol-related problems (including 
intoxication) , and the perceived need for improved societal responses to 
reduce or ameliorate these problems. 



251 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: BLACK AND HISPANIC ALCOHOL PROBLEMS: A NATIONAL STUDY/NATIONAL 
INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM (NIAAA) 

TELEPHONE: 301-443-1273 

DESCRIPTION: 

NIAAA is conducting a nationwide survey of Black and Hispanic drinking 
attitudes and patterns, alcohol-related problems, and community experiences 
with problem drinking. Interviews are completed with 1,500 black and 1,500 
Hispanic respondents in a probability design representative of the adult 
Black and Hispanic populations of the 48 coterminous States. The study is 
coordinated with a nationwide survey of the general U.S. population that is 
being conducted under an Alcohol Research Center Grant. The study provides 
a comprehensive description of the distributions and interrelations of rates 
of heavy drinking and alcohol-related problems. Special attention is paid 
to subgroups of the two populations under study: Blacks, Puerto Ricans, 
Cuban Americans, Mexican-Americans living on the West Coast, and 
Mexican-Americans living in the Southwest. Also, a comparative analysis of 
patterns among Blacks, Hispanics, and Whites (especially those living in 
circumstances similar to the minority subject) is conducted. Finally, 
explanatory analysis of patterns of variation within each of the two ethnic 
populations Is done. A variety of explanatory factors derived from the 
literature are measured and analyzed to test for their potential power in 
explaining cultural specificities in Black and Hispanic drinking practices 
and problems. 



252 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: NATIONAL DRUG ABUSE MEDIA CAMPAIGN/NATIONAL INSTITUTE ON DRUG 
ABUSE (NIDA) 

TELEPHONE: 301-443-1124 

DESCRIPTION: 

A significant number of ethnic minority constituencies were not reached 
through the 1983-85 campaign. In order to be more responsive to these 
audiences, NIDA will develop strategies to expand its multicultural 
initiatives and encourage support from these groups. 

• The campaign will be expanded from the original target audiences, young 
people ages 12-14 and their parents, to include minority inner-city 
youngsters ages 10-14 years and their parents. To accomplish this 
transit ads with anti-drug messages will be developed and placed in 
subway stations; radio public service announcements with Black and 
Hispanic narrators, and a television public service announcement 
designed to reach minority parents is being developed and will be 
distributed to broadcasters throughout the country. 

• Production of the music video as part of the campaign, with an urban 
setting aimed at young people to increase audience contact. 

• Placement of a music video as part of the campaign, with an urban 
setting aimed at young people to increase audience contact. 

• Placement of announcements and articles in ethnic minority newspapers 
and magazines. 

• Drug abuse flyers developed for the initial phase of the campaign are 
being translated into Spanish for Hispanic groups and other consumers. 

• The NIDA exhibit will be presented at ethnic minority meetings and 
national conferences to reinforce the messages and increase ethnic 
minority public awareness of the health consequences of drug abuse. 

• Conduct a pretesting service to evaluate print materials, audio visuals, 
and mass media messages before final production for minority audiences. 



253 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: ETHNIC COMMUNITY INITIATIVE/NATIONAL INSTITUTE ON DRUG 
ABUSE (NIDA) /DIVISION OF PREVENTION AND COMMUNICATIONS 

TELEPHONE: 301-443-6720 

DESCRIPTION: 

NIDA's Division of Prevention and Communications (DPC) Technology Transfer 
Branch (TTB), sponsors a series of community initiative workshops to 
identify and assemble a wide range of representatives from the American 
Indian, Black, Hispanic, and Asian American population and provide a forum 
in which they may begin to address substance abuse problems in their 
respective communities. 

As part of NIDA's initiative to encourage minority groups to incorporate 
alcohol and drug abuse problems onto their national agendas and to begin to 
address prevention strategies the Institute initiated two meetings in 
Washington, D.C., for Blacks and Hispanics respectively. 

These groups established themselves as the Black Advisory Committee on Drug 
and Alcohol Abuse and Policy and the National Hispanic Coalition on Drug and 
Alcohol Abuse Prevention. 

The American Indian communities have also received extensive assistance from 
the Institute. Staff attended the annual American Indian Substance Abuse 
School in Spokane, Washington, presented workshops and held discussions with 
leaders of the American Indian communities regarding the development of 
prevention programs in their communities. Also, a special series of 
workshops ("Community Initiatives") will be scheduled for the 1985 American 
Indian Substance Abuse School. The workshops will have as their theme the 
establishment of community initiatives for prevention of drug abuse and drug 
use among American Indian youth. 



254 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: NIDA STARTER AWARD/OFFICE OF POLICY DEVELOPMENT AND IMPLEMENTATION 
(OPDI) /NATIONAL INSTITUTE ON DRUG ABUSE (NIDA) 

TELEPHONE: 301-443-6460 

DESCRIPTION: 

The purpose of this program is to recruit minority investigators and 
facilitate their entry into the drug abuse field. 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: MINORITY ACCESS TO RESEARCH CAREERS (MARC) /NATIONAL INSTITUTE ON 
DRUG ABUSE (NIDA) 

TELEPHONE: 301-443-6720 

DESCRIPTION: 

This program has three goals (1) to increase minority IPA staff, (2) to 
provide greater exposure and promotion of the MBRS program and (3) to 
develop postgraduate training of MARC graduates in an effort to bring more 
competitive minority investigators into drug abuse research. 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: PREVENTION OF DRUG ABUSE AMONG MINORITY POPULATIONS /DIVISION OF 

CLINICAL RESEARCH (DCR) /PREVENTION RESEARCH BRANCH (PRB) /NATIONAL 
INSTITUTE ON DRUG ABUSE (NIDA) 

TELEPHONE : 301-443-1514 

DESCRIPTION: 

These efforts have focused on a minority workshop and a series of monographs 
on minorities and prevention. 



255 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: TREATMENT OF DRUG ABUSE AMONG MINORITY POPULATIONS/NATIONAL 
INSTITUTE ON DRUG ABUSE (NIDA) 

TELEPHONE: 301-443-4060 

DESCRIPTION: 

The Treatment Research Branch develops and directs a nationwide program of 
drug abuse treatment research activities to evaluate and test current and 
innovative techniques for delivering drug abuse treatment services and to 
establish national treatment guidelines in areas in which guidelines are 
absent and/or treatment techniques unsuccessful. The following activities 
are of particular interest: 

• An inner-city research/clinical group is part of a grant to provide 
outreach, early treatment intervention and to evaluate the effectiveness 
of their early intervention program with Black adolescent heroin users. 

• Together with the prevention branch, TRB is Involved in a program that 
will train a cadre of Native American drug abuse counselors who will 
initiate a program of early intervention and the development of coping 
skills for Native American youth. This program is one that has the 
potential of being self-perpetuating after government funding ends. 



256 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: ETHNIC MINORITY FAMILY MOBILIZATION PROJECT /NATIONAL INSTITUTE ON 
DRUG ABUSE (NIDA) 

TELEPHONE: 301-443-2450 

DESCRIPTION: 

The Ethnic Minority Family Mobilization Project was implemented in October 
1984 in response to drug abuse problems confronting ethnic minority 
communities. Drug abuse prevention programs in ethnic minority communities 
have historically focused on the individual affected or potentially affected 
by drug use. There is a growing recognition within the prevention field 
that parents and families should be involved in the development and 
implementation of programs and approaches to prevent drug use among youth. 
The involvement of parents in developing strategies for combatting drug use 
in middle-class white communities has proven to be effective. However, 
ethnic minority parents have not been organized to the same degree. This 
initiative has been designed to stimulate the involvement of minority 
families in the prevention of drug use among youth. 

The Institute, through its Ethnic Minority Family Mobilization Project, 
will, over the next 2-1/2 years, promote the replication of successful 
ethnic minority grassroot parent group pilot projects in 10 cities across 
the country. Technical assistance may be provided to other communities in 
an effort to expand the number of ethnic minority groups involved in the 
prevention of drug abuse among minority youth. 



257 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: ESTIMATING MENTAL HEALTH NEED/NATIONAL INSTITUTE ON DRUG ABUSE 
(NIDA) 

TELEPHONE: 301-443-2974 

DESCRIPTION: 

The substance abuse supplement to this mental health grant will permit the 
comparison of survey-based estimates of drug use in a community with 
estimates based on less costly social indicators such as vital statistics 
and local data from schools, communities, and public agencies. The drug 
supplement also provides for the addition to the study of 2 Hispanic and 2 
Black population areas. In the total sample, the social indicator estimates 
will be compared with the direct surveys in 44 areas in Colorado. 



258 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: PREVENTION/ OFFICE OF PREVENTION/ NATIONAL INSTITUTE OF MENTAL 
HEALTH (NIMH) 

TELEPHONE: 301-443-6130 

DESCRIPTION: 

This program: 

• Designs national goals and establishes national priorities for the 
prevention of mental illness and the promotion of mental health; 
encourages local entities and State agencies to achieve these goals and 
priorities; and develops and coordinates Federal prevention policies and 
programs and assuring increased focus on the prevention of mental 
illness and the promotion of mental health. 

• Stimulates, develops, supports, coordinates, and monitors a variety of 
activities, including developing and convening planning workshops, 
commissioning key technical and advisory reports, preparing and 
disseminating relevant prevention information, initiating and 
facilitating policy studies, and arranging for expert consultations. 



259 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: CENTER FOR STUDIES OF THE MENTAL HEALTH OF THE AGING/NATIONAL 
INSTITUTE OF MENTAL HEALTH (NIMH) 

TELEPHONE: Karen Urbany, 11C-03 Parklawn, 443-1185 

DESCRIPTION: 

This program includes: 

• Research support programs to increase knowledge and improve research 
methods on mental and behavioral disorders; to generate information 
regarding basic biological and behavioral processes underlying these 
disorders and the maintenance of mental health; and to improve mental 
health services. 

• Research training provides support for the training of research 
scientists in the area of mental health and aging. 

• Clinical/services training which is designed to improve mental health 
and related services to the aging within both the established mental 
health service delivery system and the mental health-related support 
systems. 

• Career development. 



260 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: CENTER FOR STUDIES OF MINORITY GROUP MENTAL HEALTH/DIVISION OF 
PREVENTION AND SPECIAL MENTAL HEALTH PROGRAMS (DPSMHP) /NATIONAL 
INSTITUTE OF MENTAL HEALTH (NIMH) 

TELEPHONE: 301-443-2988 

DESCRIPTION: 

The Center for Studies of Minority Group Mental Health serves as the focal 
point, stimulator, and coordinator for the National Insitute of Mental 
Health (NIMH) research, clinical manpower development and training, and 
technical assistance activities which directly impact and improve the mental 
health of minority groups (i.e., American Indians, Alaskan Native, Asian 
American, Pacific Islanders, Blacks and Hispanics), individually and 
organizationally. Some specific projects are: 

• Factors in Adolescent Suicide - The purpose of this research is to 
investigate the social and cultural factors contributing to a sharp 
increase in the rate of suicide among adolescent males over the last 20 
years in Micronesia. The suicide rate among adolescent males (15-24 
years) has reached proportions surpassing the reported rates for the 
same cohort among other national population or cultural groups. 

• Folktales as Therapy with Hispanic Children - "Tell-me-a-story" (TEMAS I) 
is a culturally sensitive therapy modality which incorporates: 1) the 
Puerto Rican heritage as manifested in the folktales; 2) the mother as a 
sacred figure in the Puerto Rican family; and 3) adaptive ego functions 
as reflected in the dominant U.S. culture. The present study explores 
whether TEMAS I is an effective treatment modality and whether Puerto 
Rican mothers are effective therapeutic agents as compared with 
professional therapists. 

• Black Family Mental Health and Teenage Pregnancy - This project 
examines: 1) issues of sexuality and childbirth in the Black teenager; 
2) the coping strategies and response styles associated with teenage 
pregnancy in Black families; 3) isolate the variables associated with 
family mental health support systems; and 4) given the cultural meaning 
of teenage pregnancy, specify what measurable effects adolescent 
pregnancy has on the teenager, the offspring, and the teenager's family. 

• Health and Behavior: Research Agenda for Amerinds - The purpose of this 
conference is to generate a research agenda specific to American Indians 
and Alaskan Natives, a population in which these issues and directions 
assume special importance for intervention as well as prevention. 



261 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: CENTER FOR STUDIES OF ANTISOCIAL AND VIOLENT BEHAVIOR/ /NATIONAL 
INSTITUTE OF MENTAL HEALTH (NIMH) 

TELEPHONE: 301-443-3728 

DESCRIPTION: 

The NIMH Center for Studies of Antisocial and Violent Behavior, in 
cooperation with the NIMH Center for Studies of Minority Group Mental 
Health, has provided funds to the Centers for Disease Control for the 
establishment of new data bases on homicide deaths among young Black males 
and Hispanics. 

• A national data file for the period 1970-1982 has been established on 
homicide deaths among Black males aged 15 to 24. 

• A data file on homicide deaths among Hispanics in five southwestern 
States has been established for the years 1975-1982. 

The NIMH Center for Studies of Antisocial and Violent Behavior implemented 
an interagency agreement with Brookhaven National Laboratory for development 
of the first reliable population-based estimates on risks for homicide cases 
among Black males and females who come to hospital emergency departments as 
victims of nonfatal assaults. 

The NIMH Center for Studies of Antisocial and Violent Behavior awarded a 
contract to Dr. Fred Loya of the University of California at Los Angeles for 
analysis of factors associated with a major rise in Hispanic male homicide 
deaths in Los Angeles during the period 1970-1979. 



262 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: CENTER FOR PREVENTION RESEARCH/DIVISION OF PREVENTION AND SPECIAL 
MENTAL HEALTH PROGRAMS (DPSMHP) /NATIONAL INSTITUTE OF MENTAL 
HEALTH (NIMH) 

TELEPHONE: 301-443-4283 

DESCRIPTION: 

The Center for Prevention Research (CPR) is the focal point for activities 
related to research and training on the early preventive intervention of 
mental disorders and behavioral dysfunctions. CPR is interested in all 
aspects of preventive intervention research and therefore provides support 
for research efforts involving preventive intervention strategies which 
avoid and/or interrupt the development of mental disorders of behavioral 
dysfunctions and improve individual adaptive capabilities. CPR's goal is to 
contribute to the development of a solid empirical base for conceptualizing, 
implementing, and evaluating preventive interventions. CPR will make funds 
available for the support of prevention research in the following areas: 

• Development, testing, and evaluation of preventive interventions (to 
include research characteristics, priority areas, etc.). 

• Risk-assessment studies. 

• Methodological advances. 



263 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: CENTER FOR MENTAL HEALTH STUDIES OF EMERGENCIES/NATIONAL INSTITUTE 
OF MENTAL HEALTH (NIMH) 

TELEPHONE: 301-443-1910 

DESCRIPTION: 

The Center for Mental Health Studies of Emergencies (CMHSE), has four 
different programs: research on rape; research on emergencies; crisis 
counseling; and emergency preparedness. 

The Hispanic Social Network Prevention Intervention Study is designed to 
address a number of issues provoked by the July 18, 1984, violence which 
occurred in one prospective research site, San Ysidro, California. The 
principal investigator will: 

• Conduct an extensive screening in San Ysidro of virtually all women in 
the age rank 35 to 49 using the instrumentation from the parent project 
and, in addition, a Post Traumatic Stress measure. 

• Cooperate with and provide technical assistance to the local human 
services providers in order to develop a community wide 
intervention-planning process. 

• Carry out the procedures identified in the parent proposal for second 
level screening and grouping in order to derive a cohort suitable for 
preventive intervention using merience educativa modality. 



264 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: CENTER FOR EPIDEMIOLOGIC STUDIES/DIVISION OF BIOMETRY /CENTER FOR 
EPIDEMIOLOGIC STUDIES/NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH) 

TELEPHONE: 301-443-3774 

DESCRIPTION: 

This division serves as the focal point and coordinates Institute activities 
in mental health epidemiology and related demographic research. The 
division conducts and supports research in the following areas: 

• Mental health epidemiology and related demographic research; 

• Risk factors distribution, the national history of mental disorders in 
populations, and the related need for mental health services; 

• Longitudinal and cross-sectional surveys to assess the distribution, 
determinants, and strategies for lessening risk factors for specific 
mental disorders; 

• The development of instruments and methodologies to find and to identify 
individuals with mental disorders or at risk of developing such 
disorders; and, 

• The demographic and ecological aspects of mental disorders and the need 
and demand for mental health services. 

Additionally, it provides support for programs of research training in 
epidemiology and biostatistics. 



265 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: MENTAL HEALTH CLINICAL RESEARCH CENTERS /DIVISION OF CLINICAL 
RESEARCH/NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH) 

TELEPHONE: 301-443-3563 

DESCRIPTION: 

The Mental Health Clinical Research Centers program was developed to provide 
a stimulating and productive research environment, in a clinical or 
community treatment setting, in which biological, behavioral, and/or 
sociocultural scientists and clinicians can interact and study problems of 
classification, etiology, mechanisms, psychosocial and/or 
psychopharmacologic treatment, and prevention of severe mental disorders. 
MHCRC's are funded at either developmental or full-scale levels, and provide 
core support to bring together basic and clinical researchers focusing on 
selected problem areas. 



266 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAMS RESEARCH SCIENTIST DEVELOPMENT/NATIONAL INSTITUTE OF MENTAL HEALTH 
(NIMH) 

TELEPHONE: 301-443-4347 

DESCRIPTION: 

Major projects include: 

Mexican-American Health and Social Factors and Disease . This project will 
(1) investigate the role of psychosocial risk factors in nonclinical 
depression; (2) begin analyses of data on the mental health (depression, 
alcoholism, drug abuse) of Mexican Americans collected as part of the 
Hispanic Health and Nutrition Examination Survey by the National Center for 
Health Statistics; and, (3) begin collection of data on the reliability and 
validity of psychiatric diagnoses made with the Diagnostic Interview 
Schedule when used with Anglos and with Hispanics with varying degrees of 
acculturation into mainstream American life and with varying degrees of 
ability to speak English and Spanish who are psychiatric inpatients at San 
Antonio State Hospital. 

Factors Affecting the Mental Health of Afro-American Women . In this study a 
quote sample of 100 Afro-American women from 18 to 35 years of age who are 
characteristic of Afro-American women residing in Los Angeles County by age, 
level of education, marital status and the presence of children will be 
interviewed at their choice of locations. A comparison group of white 
American women, matched on the above criteria will also be interviewed. 
Survey research techniques are utilized in a socioculturally sensitive model 
of sex research. This model was developed with Afro-American women and 
identifies aspects of their socialization to sexuality and mental health 
that are culturally specific. It may also have utility in research with 
women ranging in age and ethnic group affiliations. 



267 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: NIMH MINORITY BIOMEDICAL RESEARCH SUPPORT /NATIONAL INSTITUTE OF 
MENTAL HEALTH (NIMH) 

TELEPHONE: 301-443-4337 

DESCRIPTION: 

The NIMH Minority Biomedical Research Support Program of the Division of 
Extramural Research programs and the ADAMHA Minority Access to Research 
Careers (MARC) Program of the Division of Human Resources plan to jointly 
convene a Historically Black Colleges and Universities workshop in an effort 
to increase the number and quality of research and research training 
applications submitted to the Institute and to increase the number of 
fundable applications submitted to NIMH. 

Some projects include: 

Biofeedback control as a function of subject and task variables. 

The emergence of semantic categories in the language of black children. 

Detection versus control of stress-related physiological variables. 

Internal and external aspects of obesity. 

Physiological and subjective reactions to stressful imagery. 

Aging and motivation: Biobehavioral and psychopharmacology studies. 



268 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: CLINICAL RESEARCH BRANCH /NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH) 

TELEPHONE: 301-443-4524 

DESCRIPTION: 

The purpose of this program is to increase knowledge regarding the bases and 
clinical aspects of mental and emotional disorders as well as the inter- 
active relationships of these disorders with general health status. NIMH 
provides support in the following areas : 

• Basic and clinical research on the nature and description, diagnosis and 
classification, etiology, course, prognosis, and followup of mental 
disorders, and the development and improvement of theories, methods, and 
technologies for such investigations. 

• Studies of clinical and subclinical populations, populations at high 
risk for clinical disorders, ethnic or cultural groups, and other normal 
populations where the aim is to collect either control or baseline data 
on clinical variables directly relevant to a better understanding of 
clinical processes or etiological mechanisms; human or animal studies 
using experimentally induced states (e.g., stress-induced states, models 
or experimentally induced psychopathologic states) ; cross-cultural or 
cross-ethnic research in psychopathology; and studies of family and 
cultural factors in the etiology, expression, diagnosis, and outcome of 
mental disorders. 

• Studies at the interface of biomedical and behavioral research as they 
pertain to physical disorders where the major focus of the research is 
on the prevention of mental disorders or on techniques to measure coping 
behaviors and cognitive, emotional, motivational, or other psychosocial 
correlates in relation to health status. 

An example of a specific project is The Course of Schizophrenia Among 
Mexican Americans . This project examines the influence of family and social 
factors on the outcome of schizophrenic illness among British patients, 
using a Southern California population of Mexican American patients; the 
relationship between the level of a key relative's expressed emotion (EE) 
and a patient's relapse in regard to other social/familial factors; and 
explores the role of communication deviance and relationship with (EE) in 
the household and relapse. 



269 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: SMALL GRANT PROGRAM/NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH) 

TELEPHONE: 301-443-4337 

DESCRIPTION: 

This program provides relatively rapid financial support which is 
principally intended for newer, less experienced investigators, those at 
small colleges, and others who do not have regular research grant support or 
resources available from their institutions. Small grants may be used to 
carry out exploratory or pilot studies, to develop and test a new technique 
or method, or to analyze data previously collected. The direct cost limit 
for the Small Grant Program applications is $15,000 and the support is 
limited to a 1-year period and is not renewable. 

This program invites applications for research grants which cover the entire 
range of scientific areas relevant to mental health, or to drug or alcohol 
abuse. While proposals may involve a wide variety of biomedical, behavioral 
and related disciplines, relevance to the missions of the ADAMHA Institutes 
must be present. 



270 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: PSYCHOSOCIAL TREATMENTS RESEARCH/NATIONAL INSTITUTE OF MENTAL 
HEALTH (NIMH) 

TELEPHONE: 301-443-4527 

DESCRIPTION: 

The Psychosocial Treatments Branch is authorized to plan, initiate, and 
support, by means of grants, cooperative agreements, and contracts, such 
research as may advance knowledge permitting the more effective treatment of 
the full range of mental disorders suffered by children, adolescents, and 
adults. For example, there is an ongoing study to investigate the relative 
impact of Individual Psychodynamic Child Therapy (IPCT), Structural Family 
Therapy (SFT), and a Naturalistic Control Condition (NCC) on elementary 
school age Cuban children and their families. The differential impact of 
these therapeutic strategies will be assessed for 67 Cuban children who 
present problems in the categories of conduct disorders and 
anxiety-dependency problems. 



271 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: CHILD AND ADOLESCENT SERVICE SYSTEM PROGRAM (CASSP) /OFFICE OF 

STATE AND COMMUNITY LIAISON ( OS CL) /NATIONAL INSTITUTE OF MENTAL 
HEALTH (NIMH) 

TELEPHONE: Judith Katz-Leavy, 11C-17 Parklawn, 301-443-3604 

DESCRIPTION: 

To insure the availability of a comprehensive, coordinated system of care 
for mentally disturbed children and youth in communities by assisting 
States in assuming a leadership role and by improving State level 
planning and technical assistance capacities to meet the service needs of 
severely disturbed children and adolescents on a statewide basis. This 
statewide service system improvement approach has the potential for a 
broad, nationwide impact on systems of care for mentally disturbed 
children and youth. 

The CASSP has implemented a major technical assistance, training, and 
knowledge exchange program through two interagency agreements. These 
agreements will be used to provide onsite technical assistance to both 
funded CASSP and unfunded States; to support training and dissemination 
activities focusing on the needs of seriously emotionally disturbed 
children; to conduct research in areas important to the development of 
the CASSP concept; and to conduct short-term studies related to service 
system improvement for this population. 



272 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: COMMUNITY SUPPORT PROGRAM/ COMMUNITY SUPPORT AND REHABILITATION 
BRANCH (CSRB) /OFFICE OF STATE AND COMMUNITY LIAISON 
(OSCL) /NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH) 

TELEPHONE: 301-443-3653 

DESCRIPTION: 

Initiated in 1977, the NIMH Community Support Program (CSP) works with 
States and localities to improve opportunities and services for adults with 
chronic mental illness. CSP focuses specifically on those adults who are 
inappropriately institutionalized in hospitals or nursing homes, and the 
larger number of such Individuals who are living outside of hospitals 
without adequate housing or life support services — estimated at 1.7 to 2.4 
million persons. 



273 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: NATIONAL RESEARCH SERVICE AWARD/DIVISION OF HUMAN RESOURCES 
(DHR) /NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH) 

TELEPHONE: 301-443-3855 

DESCRIPTION: 

This program is intended to assist institutions with substantial minority 
enrollment In the training of greater numbers of scientists and teachers in 
fields relating to alcoholism, drug abuse, and mental health. The primary 
objectives are: 

• Increase the number of well-prepared students from institutions with 
substantial minority enrollment who can compete successfully for entry 
into Ph.D. degree programs in disciplines related to alcoholism, drug 
abuse, and mental health, and 

• Help develop and strengthen biobehavioral, psychological, social, and/or 
public health sciences curricula and research training opportunities in 
institutions with substantial minority enrollment in order to prepare 
students for research careers related to alcoholism, drug abuse, and 
mental health. 



274 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: MENTAL HEALTH CLINICAL TRAINING/DIVISION OF HUMAN RESOURCES 
(DHR) /NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH) 

TELEPHONE: 301-443-5850 

DESCRIPTION: 

Workshop on Minority Mental Health Educational processes - This workshop, 
comprised of minority mental health education experts from the four core 
mental health disciplines, was designed for the purpose of focusing 
attention on minority mental health training activities in the mental health 
professions and eliciting recommendations for the continued refinement and 
enhancement of mental health education for minorities. Nine minority mental 
health educators presented papers reflecting their perceptions of what has 
been accomplished to date, the continued need for minority mental health 
education, and ideas for future programming directions. The workshop has 
resulted in a substantial internal Division of Human Resources 
"publication," which will be distributed appropriately for the purpose of 
advancing minority mental health education in the several disciplines. 



275 



ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION 

PROGRAM: NATIONAL REPORTING PROGRAM/ SURVEY AND REPORTS BRANCH 
(SRB) /NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH) 

TELEPHONE: 301-443-3343 

DESCRIPTION: 

The Survey and Reports Branch is organized into three interrelated research 
programs: the Inventory Research Program, the Sample Survey Research 
Program, and the Developmental and Special Populations Research Program. 
The Inventory and Sample Survey Research Programs conduct the organizational 
inventories and patient/client surveys that comprise the National Reporting 
Program for Mental Health Statistics. The Developmental and Special 
Populations Research Program engages in research to develop methodologies 
and extend the scope of coverage for the inventories and surveys. In 
addition, this program serves as a focal point within NIMH for research on 
the chronically mentally ill and the homeless mentally ill through a range 
of intramural and extramural activities. Items of interest are: 

• The 1985 Combined Inventory of Mental Health Organizations - This 
inventory of General Hospital Mental Health Services will collect 
enumeration data on minorities served in all mental health organizations 
in the United States. 

• The 1985 Patient Sample Survey of Inpatient, Outpatient, and Partial 
Care Organizations will collect detailed patient data on minorities 
admitted, under care, or terminated from mental health organizations. 

• The 1985 Inventory of State Prison Mental Health Services will enumerate 
minorities receiving mental health services in these settings. 



276 



CENTERS FOR DISEASE CONTROL 
PROGRAM: INVESTIGATIONS AND TECHNICAL ASSISTANCE 
TELEPHONE: 404-329-3243 
DESCRIPTION: 
The objectives of this program are: 

• To assist State and local health authorities and other health related 
organizations in controlling communicable diseases, chronic diseases and 
other preventable health conditions. Investigations and evaluation of 
all methods of controlling or preventing disease are carried out by 
providing epidemic aid, surveillance, technical assistance, 
consultation, and by providing leadership and coordination of joint 
national, State, and local efforts. 

• To strengthen State and local disease prevention and control programs, 
such as tuberculosis, childhood immunization, and venereal disease. 

Services are provided in the following areas: epidemic aid; technical 
assistance (field studies and investigations of ongoing disease problems; 
occupational safety and health); consultation; dissemination of technical 
information; provisions of specialized services and assistance, Including 
responses to public health emergencies such as Love Canal and Mount St. 
Helens. Additionally, there is training of State and local health 
professionals in broad areas of epidemiology, at State's request, in such 
specific areas as hospital infections, rabies, hepatitis, and venereal 
disease. 



277 



CENTERS FOR DISEASE CONTROL 

PROGRAM: INJURY PREVENTION (IP) 

TELEPHONE: 404-329-3243 

DESCRIPTION: 

This project will assist in the development of a national injury 
surveillance system and a comprehensive injury prevention demonstration 
program for selected Indian reservations. 



CENTERS FOR DISEASE CONTROL 

PROGRAM: CHILDHOOD IMMUNIZATION GRANTS (CIG) 

TELEPHONE: 404-329-3243 

DESCRIPTION: 

These grants assist States and communities in establishing and maintaining 
immunization programs for the control of vaccine preventable disease of 
childhood (including measles, rubella, poliomyelitis, diphtheria, pertussis, 
tetanus, and mumps). 

Projects grants are awarded to any State, and in consultation with State 
health authorities, political subdivisions of States and other public 
entities. Private individuals and private nonprofit agencies are not 
eligible for immunization grants. 



278 



CENTERS FOR DISEASE CONTROL 

PROGRAM: OCCUPATIONAL SAFETY AND HEALTH - RESEARCH GRANTS (OSH) 

TELEPHONE: 404-329-3243 

DESCRIPTION: 

These grants are intended to further the understanding of the underlying 
characteristics of occupational safety and health problems in the general 
industry and in the mining industry and for effective solutions in dealing 
with them; to eliminate or control factors in the work environment which are 
harmful to the health and/or safety of workers; and, to demonstrate 
technical feasibility or application of a new or improved occupational 
safety and health procedure, method, technique, or system. 

Project grants are awarded to individual State or local governments, public 
and state colleges or universities, private, junior and community colleges 
and public or private agencies or institutions capable of conducting 
research in the field of occupational safety or health. 



CENTERS FOR DISEASE CONTROL 

i 

PROGRAM: OCCUPATIONAL SAFETY AND HEALTH - TRAINING GRANTS (OSH) 

TELEPHONE: 404-329-3243 

DESCRIPTION: 

These funds are intended to develop specialized professional personnel in 
occupational safety and health problems with training in occupational 
medicine, occupational health nursing, industrial hygiene, and occupational 
safety. 



279 



CENTERS FOR DISEASE CONTROL 

PROGRAM: HEALTH PROGRAMS FOR REFUGEES (HPR) 

TELEPHONE: 404-329-3243 

DESCRIPTION: 

This program assists States and localities in providing health assessments 
to newly arrived refugees and in addressing refugee health problems of 
public health concern. 

Projects grants are awarded to official State health agencies and, in 
consultation with the State Health agency, health agencies of political 
subdivisions of a State. 



280 



CENTERS FOR DISEASE CONTROL 

PROGRAM: VENEREAL DISEASE CONTROL GRANTS (VDC) 

TELEPHONE: 404-329-3243 

DESCRIPTION: 

The purpose of these grants is to reduce morbidity and mortality by 
preventing cases and complications of these diseases. Project grants under 
Section 318c are awarded to State and local health departments. These 
grants emphasize the develoment and implementation of nationally uniform 
control programs which focus on disease intervention activities designed to 
reduce the incidence of these diseases, with education activities supporting 
these basic program activities authorized under 318b. 

Projects grants are awarded to any State and, in consultation with the 
appropriate State Health authority, any political subdivision of a State. 



CENTERS FOR DISEASE CONTROL 

PROGRAM: VENEREAL DISEASE RESEARCH, DEMONSTRATION, AND PUBLIC INFORMATION 
AND EDUCATION GRANTS 

TELEPHONE: 404-329-3243 

DESCRIPTION: 

These grants are used to develop, improve, apply, and evaluate mthods for 
the prevention and control of syphilis, gonorrhea, and other sexually 
transmitted diseases (STD) through demonstration and applied research; to 
develop, improve, apply, and evaluate methods and strategies for public 
information and education about syphilis, gonorrhea, and other STD; and to 
support particularly deserving public information and education programs 
which cannot be supported through other grant programs. 

Projects grants are awarded to any State, political subdivisions of States, 
and any other public or private nonprofit institutions. 



281 



CENTERS FOR DISEASE CONTROL 

PROGRAM: PROJECT GRANTS AND COOPERATIVE AGREEMENTS FOR TUBERCULOSIS CONTROL 
PROGRAMS 

TELEPHONE: 404-329-3243 

DESCRIPTION: 

This program assists State and local health agencies in carrying out 
tuberculosis control activities designed to prevent transmission of 
infection and disease. The goal is to ensure an average annual reduction of 
reported tuberculosis cases of at least 5 percent. 

Projects grants, under Section 317 of the Public Health Service Act, are 
awarded to official public health agencies of State and local governments, 
including the District of Columbia, and Commonwealth of Puerto Rico, the 
Virgin Islands, Guam, the Trust Territory of the Pacific Islands, the 
Northern Mariana Islands, and American Samoa. Private individuals or profit 
and private nonprofit agencies are not eligible for these grants. 



CENTERS FOR DISEASE CONTROL 

PROGRAM: COOPERATIVE AGREEMENTS FOR STATE-BASED DIABETES CONTROL PROGRAMS, 
DIABETES CONTROL (DC) 

TELEPHONE: 404-329-3243 

DESCRIPTION: 

The purpose of this program is to improve the quality of life and 
effectiveness of health services for diabetics. 

Projects grants are awarded to eligible applicants of official State health 
agencies of the U.S., the District of Columbia, the Commonwealth of Puerto 
Rico, the Virgin Islands, Guam, the Trust Territory of the Pacific Islands, 
the Northern Mariana Islands, and American Samoa. 



282 



CENTERS FOR DISEASE CONTROL 

PROGRAM: VIOLENCE EPIDEMIOLOGY BRANCH/CENTER FOR HEALTH PROMOTION AND 
EDUCATION (CHPE) 

TELEPHONE: 404-329-3521 

DESCRIPTION: 

Major projects include: 

Information and Education - Suicide . CDC has prepared a Suicide 
Surveillance Report which presents and analyzes information on national 
trends In suicide for the years 1970-80. This report Is based on published 
and unpublished data derived from NCHS death certificate information. 
Objectives of the report include a) dissemination of suicide statistics to 
focus attention on suicide as a public-health problem; b) delineation of 
populations at high risk for suicide to direct suicide prevention efforts 
toward these groups; and c) stimulation of the collection of specific 
information on suicide and suicide "clusters" at the State or local level. 
This information is broken down by race-specific categories. 

Research (Epidemiology) /Homicide/Suicide . There has never been a 
comprehensive study of the incidence of mortality due to suicide and 
homicide among Hispanics in the United States. Although sixteen million 
Hispanics live in this country, national mortality statistics cannot 
identify deaths to Hispanics as a specific ethnic subgroup. Thus, Hispanic 
ethnicity has not been epidemiologically examined as risk factor related to 
suicide and homicide as a cause of death, because of a lack of sufficient 
data. CDC is attempting to rectify that problem by studying the incidence 
of suicide and homicide specifically among the largest segment of Hispanics 
in the United States — Hispanics (primarily Mexican Americans) living in five 
States near the U.S. -Mexico border. 

Research (Epidemiology) - Domestic Violence . CDC has undertaken a project 
to examine the feasibility of establishing a surveillance system for 
monitoring the incidence of domestic violence between adults at the national 
and local levels. Consequently, basic descriptive and analytic epidemiology 
in this area remains largely uncharted. Collecting data on the morbidity 
and mortality associated with domestic violence would be a logical first 
step, but it is not yet clear how to go about establishing such a data 
collection system. This study will help to specify appropriate procedures 
for the collection of data on domestic violence, the ability of State and 
local health departments to acquire such data, and their capacity to 
disseminate and utilize limited resources effectively in planning and 
implementing model domestic violence surveillance systems. 

Research (Epidemiology) - Domestic Violence . CDC, in cooperation with the 
Atlanta Department of Public Safety and the Georgia Department of Human 
Resources, plans to review cases of domestic violence (homicides and 
non-fatal assaults between family and intimates). The results of this study 
will provide information on 1) the role of health, social service, law 



283 



enforcement, and judicial agencies with respect to their contact with 
affected families prior to death or assault; 2) the contacts these agencies 
may have had with each other regarding the affected families; 3) situational 
variables which precede death or assault; and 4) programmatic suggestions 
regarding health and social service agency capability to respond effectively 
and prevent violence in such cases. This study will have particular 
relevance for the understanding of violence among Blacks since they are at 
high risk for injuries resulting from domestic violence and constitute a 
large proportion of the study population. 

Information and Education - Homicide . As a part of a reimbursable agreement 
with the National Institute of Mental Health, CDC will be producing a 
homicide surveillance report focusing on Black and Hispanic minority groups 
in the United States. The purpose of this report is to a) document the 
patterns and rates of homicide of high risk minority groups; and b) provide 
up-to-date information on the magnitude and nature of the homicide problem 
within these groups. 

Research (Epidemiology) - Homicide . In collaboration with researchers at 
the Neuro-psychiatric Institute of the University of California at Los 
Angeles, CDC has undertaken a large study examining patterns of homicide 
victimization in Los Angeles between 1970 and 1979. This study will 
examine: a) patterns of homicide victimization in high risk Anglo, Black, 
and Hispanic race ethnic groups; b) the association of alcohol and drug use 
with homicide victimization (this part of the study is part of a 
reimbursable agreement with the National Institute of Justice); and c) 
intervention/prevention strategies for reducing the incidence of the 
predominant forms of homicide affecting high risk population categories in 
Los Angeles. 



284 



FOOD AND DRUG ADMINISTRATION 

PROGRAM: CENTER FOR FOOD SAFETY AND APPLIED NUTRITION (CFSAN) 

TELEPHONE : 202-245-1198 

DESCRIPTION: 

The goals of this program are health promotion and disease prevention. The 
long term strategy for meeting these goals is to improve the nutrition 
scientific knowledge base that is needed for policy decisions, regulatory 
actions and education efforts, and to monitor and influence dietary and 
technological trends that may impact on the nutritional health status of the 
American public and on the nutrient quality of their food supply. The 
strategy is pursued by maintaining a high quality research capability in 
several areas. Two of these areas involve applied laboratory research that 
addresses CFSAN strategic goals In an Integrated Nutrition-Toxicology 
Program and in Food Science/Food Technology. A third area is research in 
nutrient analysis. Another important facet of the strategy is research on 
and monitoring of the nutrient content of selected foods and the nutrition 
status of the public, fostering of sound nutrition practices by normal 
persons and persons with abnormal or disease conditions, and providing to 
consumers opportunities to improve their understanding and awareness of 
foods and nutrition. Finally, as part of the strategy, the Nutrition 
Program will serve as a focal point for the Department's nutrition 
objectives by shouldering most of the responsibility assigned to FDA for 
overseeing the refinement and monitoring of implementation plans for those 
objectives. The Department objectives include: dietary control of obesity, 
blood cholesterol levels, sodium intake, and iron deficiency anemia; 
increased public and professional awareness of dietary factors influencing 
health and disease; improved nutrition labeling of food and improved 
nutrition education programs; and improved surveillance and evaluation of 
the public's nutrition and health status. 



285 



FOOD AND DRUG ADMINISTRATION 

PROGRAM: TASK FORCE TO INCREASE INTERACTION WITH MINORITY HEALTH 
PROFESSIONAL SCHOOLS/OFFICE OF HEALTH AFFAIRS (OHA) 

TELEPHONE: 301-443-5470 

DESCRIPTION: 

This task force's goal is to increase interactions with the minority health 
professional schools. Membership consists of representatives for the 
Centers and the Commissioner's office and management staff as well as the 
schools represented in the Association of Minority Health Professional 
Schools. The task force plans to coordinate on four areas: 

• Contracts and grants. 

• Recruitment. 

• Professional exchange. 

• Advisory committee membership. 

The task force will discuss initiatives or programs that the Agency has and 
which the minority schools might join in such efforts. 



286 



FOOD AND DRUG ADMINISTRATION 
PROGRAM: OFFICE OF CONSUMER AFFAIRS 
TELEPHONE: 301-443-5006 
DESCRIPTION: 
Major projects include: 

• Black College Consumer Education Training Conference 

In September 1984, a contract was awarded to Morehouse College, Atlanta, 
GA, to plan, coordinate, implement, and evaluate a three-phase consumer 
education training conference with primary focus on and involvement with 
Black college students, faculty, and community liaison and leadership. 

The primary focus will be on "how to deliver" the consumer education 
message to the Black consumer through the formation and utilization of 
a coalition of consumers, health professionals, students, and the pri- 
vate sector. The conference will involve a cross representation of 
the consumer and health professional communities, as well as the 
private sector, but primarily the Historically Black Colleges and 
Universities' populations; and it will serve as a model for subsequent 
national, regional, and State consumer education conferences via Black 
colleges. The coalition formation will also serve as a model for other 
parts of the country as a viable resource for other FDA activities. 

• Hispanic Consumer Education - "Consumer Help Line" 

The Los Angeles District Office is conducting a consumer education 
program in conjunction with the Hispanic Consumer Advocates and Radio 
KALI in Los Angeles, CA. The program, implemented with funding assis- 
tance from FDA's Office of Consumer Affairs, is aimed at improving the 
protection of the Hispanic consumer through education and information. 

The project consists of a "Consumer Help Line," staffed by volunteers, 
one day per week/ four hours per day, using the facilities of Radio 
Station KALI, Los Angeles, CA. 

• Project Health PACT - Puerto Rico 

On June 29, 1984, FDA's Office of Consumer Affairs awarded a contract to 
the University of Colorado's Health Sciences Center to develop, implement, 
and evaluate an adapted version of Project Health PACT for Hispanic 
audiences in Puerto Rico. 

Health PACT is a consumer health education program developed at the 
University of Colorado Health Sciences Center which teaches children 
from preschool through high school how to participate with health care 
providers during health care visits. The children learn to resolve 
problems and develop appropriate plans of care by collaborating with 
the health care provider. Health PACT teaches children to communicate 



287 



effectively with health care providers through the use of five health 
consumer behaviors. 

• Sodium Reduction Consumer Education Program 

The program was conducted in the cities of New York; Richmond, Virginia; 
Dallas, Texas; and Fort Wayne, Indiana. It is part of the Agency's 
priority sodium initiatives to encourage consumers to reduce their salt 
intake. 

Educational materials developed for use with the program were: 

— Four low literacy and culturally specific program pamphlets titled 
"Why and How to Reduce Sodium, " "How to Shop For and Prepare Foods 
Low in Sodium," "Bringing and Eating Out." 

— Three culturally specific posters to illustrate "Youth and Sodium," 
"Salt Substitute," and "Elderly and Sodium." 

— A bibliography of low sodium cookbooks. 

• Hispanic Patient Education Project 

Last year, FDA's Office of Consumer Affairs and Orlando District Office 
collaborated to meet the special needs of Florida's Hispanic community. 
The Orlando District established a local Planning Board in Miami to 
develop recommendations for a Hispanic Patient Education Project. This 
advisory board includes representatives from Hispanic health professionals, 
community, and consumer organizations in Miami. 

The "kick-off" of this phase will be a 30-minute television program on 
patient education, to be aired around April 1985, developed by Up- 
Front, Inc., a local non-profit organization specializing in drug 
education/information services, with the assistance of other Hispanic 
health professionals. At the end of the television program, a 24-hour 
Medication Information System where local Hispanic consumers will be 
able to call in for information will begin its operations. University 
students from health-related careers will be answering a telephone 
line four to six hours a day, working for credit on a rotational basis, 
while at the same time gaining experience in the drug information 
field. During the rest of the 24-hour period, the system will be 
answered by taped medication information messages. Program will be 
supplemented by handouts and newspaper columns. The program will 
continue through September 31, 1985. 



288 



FOOD AND DRUG ADMINISTRATION 

PROGRAM: COMMUNICATIONS 

TELEPHONE: 301-443-3220 

DESCRIPTION: 

The functions of this program include preparation and distribution mainly 
through field offices of publications, newspaper columns, slide shows, 
video tapes, and radio scripts containing medical and nutritional 
information relating to the needs of Hispanics and Blacks. 



FOOD AND DRUG ADMINISTRATION 

PROGRAM: CONSUMER AFFAIRS EDUCATION PROGRAM (FIELD OFFICES) 

TELEPHONE: 301-443-4166 

DESCRIPTION: 

This program conducts education programs for consumers in the area of 
food safety and nutrition labeling; drugs and biologies; radiological 
health products and medical devices; and health fraud. These programs 
were designed to educate and inform consumers about all products regu- 
lated by FDA — safety and efficacy and benefit/risk factors. The objective 
was to help consumers make positive behavior changes and intelligent 
decisions in the marketplace about FDA-related products. 



289 






HEALTH CARE FINANCING ADMINISTRATION 



PROGRAM: MEDICARE 

TELEPHONE: 301-597-5985 

DESCRIPTION: 

The Medicare program covers hospital, physician, and other medical ser- 
vices for persons aged 65 and over, disabled persons entitled to Social 
Security cash benefits for twenty-four consecutive months, and most 
persons with end-stage renal disease. Medicare has two complementary, 
but distinct, parts: Hospital Insurance (HI), known as Part A, and 
Supplemental Medical Insurance (SMI), known as Part B. The Hospital 
Insurance program covers 90 days of inpatient hospital care in a benefit 
period ("spell of illness") — which begins with hospitalization and ends 
when the beneficiary has not been an inpatient in a hospital or skilled 
nursing facility (SNF) for 60 continuous days. Nearly everyone covered 
by hospital insurance voluntarily enrolls in the SMI program. Unlike the 
HI program, SMI coverage is contingent upon the payment of a monthly 
premium. The SMI program provides payments for physicians as well as 
related services and supplies ordered by the physician. SMI also covers 
outpatient hospital services, rural health clinic visits, and home health 
visits. 



290 



HEALTH CARE FINANCING ADMINISTRATION 



PROGRAM: END-STAGE RENAL DISEASE 

TELEPHONE : 

DESCRIPTION: 

End-stage renal disease (ESRD) is the condition in which the kidneys 
permanently cease to function at a level that will support life. The two 
basic therapies for treating this condition are dialysis and transplanta- 
tion. Coverage began on July 1, 1973. ESRD beneficiaries comprise about 
one-fourth of 1 percent of all Medicare beneficiaries. In 1983, they 
accounted for an estimated 3.7 percent of total Medicare expenditures 
(Parts A and B) and 8.5 percent of Part B expenditures. 



291 






HEALTH CARE FINANCING ADMINISTRATION 



PROGRAM: MEDICAID 

TELEPHONE : 

DESCRIPTION: 

Medicaid is a Federally supported and State administered assistance 
program that provides medical care for certain low income individuals and 
families. Medicaid accounted for over $23 billion in Federal and State 
expenditures for medical services in FY 1980. The program is designed to 
provide medical assistance to those groups or categories of people who 
are eligible to receive cash payments under one of the existing welfare 
programs established under the Social Security Act; that is Title IV-A, 
the program of Aid to Families with Dependent Children (AFDC) ; or Title 
XVI, the Supplemental Security Income (SSI) program for the aged, blind, 
and disabled. In most cases, receipt of a welfare payment under one of 
these programs means automatic eligibility for Medicaid. In addition, 
States may provide Medicaid to the "medically needy," that is, to people 
who (1) fit into one of the categories of people covered by the cash 
assistance programs (aged, blind, or disabled individuals or members of 
families with dependent children when one parent is dead, absent, inca- 
pacitated, or at State discretion - unemployed), and who (2) are not 
recipients of cash assistance but whose income falls below certain levels. 

Based on 1983 data and projects for the fifty States and the District of 
Columbia, Medicaid recipients were 60.7% white, 31.9% Black, 5.4% Hispanic, 
1.9% Native Americans, and .9% Asian/Pacific Islander (may not equal 100% 
due to rounding of figures) . 



292 



HEALTH CARE FINANCING ADMINISTRATION 



PROGRAM: RESEARCH AND DEMONSTRATION 

TELEPHONE: 301-594-7476 

DESCRIPTION: 

Specific activities of interest focused on the FY 1985 strategies for 
eliminating barriers. Minorities were assisted in understanding and 
responding to the competitive process and nature of grants, cooperative 
agreements, and contracts. This had been a major factor in preventing 
minorities from participating in the research demonstrations and con- 
tracting activities. Consistent with these activities, HCFA will use 
Cooperative agreements, when appropriate. 

Staff members of HCFA have given a great deal of time, support, and 
encouragement to the Black Colleges and Universities and other minority 
programs, in particular the Hispanic. Contacts were made, information 
and data were shared, and conferences were conducted. Additionally, 
there were numerous telephone calls and correspondence. 



293 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 



PROGRAM: INDIAN HEALTH SERVICE (IHS) 
TELEPHONE: (As provided below) 
DESCRIPTION: 

• Hospitals and Clinics 

The hospital and health clinic activity represents the core of IHS 
programs and includes: hospital inpatient care, ambulatory patient 
care, eye care, model diabetes program, emergency medical services, 
laboratory services, and radiology services. These programs are 
operated by both the IHS and the tribes. The programs operated by 
the tribes provide bascially the same health services as are provided 
by IHS operated programs. The IHS health delivery system includes 47 
hospitals, 84 health centers, and over 300 smaller health stations and 
satellite clinics. The tribal health delivery system, through con- 
tractual arrangements with the IHS, encompasses four hospitals and 
over 250 health clincs. (TELEPHONE 301-443-3024) 

• Clinical Research 

In 1978, the IHS was authorized to expend directly or by contract 
specified minimal amounts of funds for research in each of five 
identified activities — patient care, field health, dental care, 
mental health, and alcoholism. Each year since then the IHS has 
funded research in these five categories. (TELEPHONE: 602-261-2186) 

• Dental Program 

Dental services to American Indians and Alaskan Natives are provided 
through a variety of means including IHS clinics, tribal programs and 
contract care. Clinics are located in close proximity to beneficiary 
groups. Where population groups are small, mobile dental untis or 
portable equipment may be utilized. Purchase of dental care under 
contract can also be an effective mechanism for serving small popula- 
tions in locations where private dentists are available and their 
services are acceptable to the Indian community. 

The dental program strives to achieve a balance between immediate 
clinical treatment and long-term results through prevention and educa- 
tion. In order to decrease the incidence of active disease conditions, 
dental staff are increasing their efforts to make patients and com- 
munities aware of the benefit of available disease prevention tech- 
niques. The delivery of these public health priority services con- 
tinues to be the basis for the delivery of oral health services in 
order to maximize oral health gains for all ages. 
(TELEPHONE: 301-443-1106) 

Nursing Education Center for Indians 

This is a work study program which allows Indians to achieve a degree 

or license in Nursing. (TELEPHONE: 301-443-1830) 



294 



Alcoholism Treatment 

The Alcoholism Program Branch was created to manage the alcoholism 
treatment programs transferred from NIAAA for the purpose of treatment 
and control of alcoholism as mandated by Congress in P.L. 94-437. The 
following activities have been achieved in the past three years : 

— A data management system was developed to assure quality services and 
accountable and sound management of programs. 

— A National Fetal Alcohol Syndrome research and prevention project has 
been implemented. 

— An alcoholism training package has been developed for the primary 
care providers. 

— Drafts for an employee counseling service program have been developed 
by two IHS Area Offices that will eventually lead to an IHS-wide 
program effort. 

— An annual indepth evaluation of all IHS alcoholism programs has been 
implemented. This evaluation will identify the strengths of programs 
in outcome, cost, and overall effectiveness. (TELEPHONE: 
301-443-4297) 

Central Diabetes Program 

This program is developing health care delivery models which are 
documented to improve the health status of diabetics. The model 
projects are prototypes so that developed methods and materials will be 
applicable IHS-wide. The staff provides direct patient services at 
clinics and supports the service of five model sites. In addition, the 
program provides three basic activities: 1) direction, training, and 
technical assistance in diabetes control (direct care — preventive); 2) 
Headquarters staff is responsible for overall program control and 
evaluation; 3) The staff also coordinates the program interface with 
interested groups within and outside IHS. Multiple groups within IHS 
such as nursing, clinical directors, nutritionists, pharmacists, etc., 
must be kept abreast of program development. Technical and consultative 
services are provided to Tribal groups nationwide. Interested outside 
organizations include the American Diabetes Association, National 
Diabetes Advisory Board, National Indian Health Board, Centers for 
Disease Control, and the National Institutes of Health. (TELEPHONE: 
505-766-3980) 

Sanitation Facilities 

The Sanitation Facilities program is authorized under the Indian 
Sanitation Facilities Act of 1959, which provides for the construction 
of water supply and waste disposal facilities for Indian homes and 
communities. Its purpose was and is to improve the health status of 
American Indians and Alaska Native people by providing them with safe 
domestic water supplies and an adequate means of waste disposal. 
American Indians and Alaska Natives have experienced a higher infant 
mortality rate and excessive rates of infectious diseases in comparison 
to the rest of the country due, in part, to the unsafe water and 
sanitary systems. 



295 



The Sanitation Facilities Construction (SFC) activity is an integral 
component of a comprehensive health services program which has as its 
goal the elevation of the health of Federally recognized American 
Indians and Alaska Natives to the highest possible level. As with the 
other activities of the IHS, sanitation facilities projects are carried 
out as a cooperative effort with the people to be served. The program 
emphasizes the "total community" concept when providing sanitation 
facilities to existing homes and communities and to newly constructed or 
renovated homes sponsored by various Federal and State agencies, tribes, 
and nonprofit organizations. 

The SFC activitiy, in conjunction with other preventive health 
activities, continues to have a major impact in the reduction of 
environmentally related diseases. It has also had a significant impact 
upon the economy of the areas where the facilities are built. In 
addition to the American Indians and Alaska Natives directly employed by 
the IHS for the construction of sanitation facilities, many other local 
Indians are employed by Indian tribes and firms that annually administer 
and/or construct 50 to 60 percent of the sanitation facilities funded 
and administered through the IHS. (TELEPHONE: 301-443-1046) 

Public Health Nursing 

This program comprises the integration of nursing practice and public 
health practice applied to the promotion and preservation of the health 
of the population. The public health nurse has responsibilities in 
general and comprehensive areas of health practice for: (a) identifying 
health needs of the individual, the family, and the community; (b) 
assessing health status and health practices; (c) implementing health 
planning based on individual and/or family care plans and community 
profile; (d) providing primary health care; and (e) evaluating the 
impact of health activities on the community. The nature of this 
practice is continuous and comprehensive, including all ages and 
diagnostic groups. The primary focus of public health nursing is on the 
prevention of illness and the promotion and maintenance of health. 
Therefore, public health nursing practice Includes the provision of 
needed therapeutic services, counseling, education, coordination, and 
advocacy activities. The public health nurse who is in constant contact 
with people in groups who seek and need health care has unique 
opportunities to identify actual and potential health problems. The 
public health nurse is involved in the planning and coordination of 
community health programs and services. 

Program efforts will be concentrated on coordination of team efforts 
both within the public health nursing group and with other health 
personnel. These efforts include: 

— Collaboration with other IHS staff and American Indians and Alaska 
Natives to plan for coordinated and expanded services. 

— Prevention of complications of pregnancy and improvements of the 
general health status of expectant mothers and their infants through 
family planning education and early care of pregnant women. 



296 



— Further reduction of infant morbidity and mortality through early 
visits to newborns, and by giving highest priority care to high risk 
infants. 

— Followup of communicable disease cases including contact 
investigation. 

— Strengthening of health teaching in homes, hospitals, clinics, 
schools, and the community, with the goal of preventing disease or 
reducing the ill effects of disease; teaching a member of the family 
to give nursing care to the non-hospitalized sick and handicapped; 
development of habits conducive of health; and increasing the 
capability of families, groups, and communities to cope with health 
problems associated with problems of daily living. 

— Provision of counseling and guidance in health and family living to 
teenagers and young adults. 

— Prevention of infectious disease in infants and children by achieving 
and maintaining a high level of immunization. (TELEPHONE: 
301-443-1840) 

Health Education 

The goal of this program is to assist the Indian people to adopt 
health-promoting lifestyles ; wisely select and use health care 
resources, products and service; and influence policy and planning on 
health care issues and larger environmental matters that affect health. 
IHS is concerned with the organized approach to all educational 
deficiencies related to specific disease as well as health and safety 
hazards among the American Indian and Alaska Natives which can be 
prevented. The ultimate goal of this program is to utilize educational 
and behavior change skills to cause the individual person to assume the 
major responsibility for taking action to bring about the best health 
possible for himself, his family, and his community. 

The traditional health education program components within the IHS 
include school health education services, community health education 
services, patient education services, staff health education support 
services, and tribal program development. Other health related 
activities are being provided by Indian tribes and Alaska Natives 
through contracts with IHS, enabling tribes to provide health education 
services. 

The goal of education in FY 1985 is to reach 50% of the 931,000 Indians 
and Alaska Natives and to impact on the lifestyle of the family and 
community. Of the ten leading causes of death, health, education will 
concentrate on alcohol and druge abuse, accident prevention, heart 
disease, and nutrition. (TELEPHONE: 301-443-1870) 

Nutrition and Dietetics 

This program is responsible for education in nutrition and nutritional 
care services for American Indians and Alaska Natives. This is 
accomplished through preventive and direct care nutrition services; 
management and operation of 48 IHS dietary departments; education and 
development of Indians in nutrition and dietetics to encourage careers 
in this health discipline; recruitment of qualified professionals for 



297 



both IHS facilities and tribally-administered health departments; 
consultation and direct services to Tribal feeding programs with food 
service and nutrition education components; assumption of the advocacy role 
in improving the quantity and nutritional quality of the food supply and 
inservice education for other members of the IHS. (TELEPHONE: 301-443-1114) 

• Scholarship Program 

This program's goal is to seek out Indian students with a desire to 
pursue a health care career and to provide the appropriate training, 
health careers orientation, counseling, financial support, and other 
supportive functions, as required, on an individual basis. The purpose 
is to increase the proportion of Indian students in health professions 
in relation to the Indian population, which has been excessively low. 

The program has achieved its goal by dramatically increasing the number 
of these Indian students, who in return payment for their scholarships, 
provide health care services to the Indian tribes. (TELEPHONE: 
301-443-5440) 

• Tribal Management 

This program supports non-recurring direct and indirect costs for 
general tribal developmental activities such as health department 
development, development or improvement of management systems, general 
health planning, evaluation, training, etc. and other activities 
designed to improve the capacity of a tribal organization to enter into 
the P.L. 93-638 contracts. Funds shall not be used to support 
operational programs or to pay for direct or indirect costs of such 
programs. (TELEPHONE: 301-443-6840) 

• Community Health Representative Program 

This program is a unique, community-based health program made up of 
indigenous (native) staff who provide a variety of health services to 
American Indian and Alaskan Native communities. 

The goal of the program is to improve the access of these communities to 
health care through the provision of community health services, 
including traditional native concepts, in multiple settings utilizing 
community-based, well-trained, medically guided paraprofessional health 
care providers. The IHS contracts with 234 American Indian and Alaskan 
Tribes and groups to manage and operate the program. The FY 1984 budget 
of $26 million supported approximately 1,550 positions and provided an 
estimated 2.2 million community-based health care services in maternal 
and child health, gerontological health care, environmental, dental, and 
general health (e.g., disease control /prevent ion, emergency medical 
services, etc.) in the home, community, and clinic settings. 
(TELEPHONE: 301-443-4644) 

• Alaska Hepatitis B Screening and Immunization Program 

The program' s ultimate goal is eradication of Hepatitis B (HBV) in 
Alaskan Natives through immunization and early detection. Short term 
goals could include regional eradication in hyperendemic areas such as 



298 



the Yukon-Kuskokwim Delta, Bristol Bay, and Iliamna by vaccinating all 
seronegative individuals, even those living in low risk villages, and 
routinely immunizing newborns in those areas. The Director, IHS, had 
decided that funding should be requested for the eradication of HBV in 
all Alaska Natives. 

Currently, over 30,000 Alaskan Natives have been tested for HBV 
seromarkers and approximately 10,000 have received at least one dose of 
HBV vaccine. All seronegative Natives residing in hyperendemic areas 
are being immunized, as well as any Natives living in villages where the 
prevalence of HBsAg is less that 2%. In addition, approximately 2,000 
prenatal women per year are being screened for HBsAg at the Arctic 
Investigations Laboratories and almost 100 babies born of HBsAg positive 
mothers have received both Hepatitis B immunoglobulin and HBV vaccine. 
HBV vaccine is now routine childhood immunization in Yukon-Kuskokwim 
Delta, Bristol Bay, and Iliamna areas. 

The program has maintained a registry of HBsAg positive persons. 
Currently, 1,500 individuals are on this register. 

This program is the first in the world to address control of HBV through 
immunization, as well as early detection of PHC in HBsAg carriers. 
Experience gained operating this program will be potentially valuable to 
the majority of countries in the world where HBV infection and PHC are 
major health problems, as well as the U.S. where the incidence of HBV 
infection is increasing. (TELEPHONE: 907-279-6661) 

Urban Health 

The purpose of this program is to encourage the establishment of 
programs in urban areas to make health services more accessible to the 
medically underserved urban Indian population. 

The 37 programs are engaged in a variety of activities, ranging from the 
provision of outreach and referral services to the delivery of direct 
comprehensive ambulatory health care. Services currently being provided 
include medical and dental services, outreach and referral services, and 
a variety of other health related services, such as family planning, 
mental health, nutrition and health education, social services, 
alcoholism counseling, home health care, etc. (TELEPHONE: 301-443-6840) 



299 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 

PROGRAM: COMMUNITY HEALTH CENTERS (CHC) 

TELEPHONE: 301-443-5295 

DESCRIPTION: 

The purpose of these centers is to provide health services to medically 
underserved populations in both urban and rural areas. During FY 1984, 575 
centers received operational funds and ambulatory health care services were 
provided to 4.8 million persons. All centers must provide a range of 
primary health care services which include basic physician services, 
preventive dental services, diagnostic laboratory and radiologic services, 
and preventive health services (including well child services and family 
planning services). Supplemental services which may be provided or arranged 
for include mental health, dental, vision, allied health, and health 
education services. 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 

PROGRAM: BLACK LUNG CLINICS 

TELEPHONE: 301-443-2270 

DESCRIPTION: 

Black Lung Clinics evaluate and treat coal miners with respiratory and 
pulmonary impairments. Services include case-finding and outreach, medical 
care (both diagnostic and treatment), education for both the patient and his 
family, and followup. 



300 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 

PROGRAM: MIGRANT HEALTH PROGRAM 

TELEPHONE: 301-443-1153 

DESCRIPTION: 

The purpose of this program is to provide support (through grants and 
contracts) for planning, developing, and delivering high quality health care 
to migrants, seasonal farm workers, and their families. Centers and 
Projects are located in "high impact areas" where groups (4,000 or more) 
reside for 2 months or longer in a calendar year. 

A variety of health services are offered at each site which includes 
primary, supplemental, educational, environmental, preventive, referral, 
etc. Centers coordinate arrangements with existing facilities and programs 
within State and local communities to provide these services. 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 
PROGRAM: HOME HEALTH SERVICES 

i 

TELEPHONE: 301-443-2270 

DESCRIPTION: 

The goal of this program is to increase the availability of home health 
services through the provision of loans and grants to entities to develop 
and expand home health agencies and to train homemaker home health aides. 

Home health services have been proven to reduce the dependency on 
institutional care (hospitals and nursing homes) which is typically more 
expensive. 

The program was reauthorized in 1984 as part of the "Preventive Health 
Amendments of 1984," P.L. 98-555. The 1985 Enacted Appropriation provided 
$3 million for the continuation of the program to provide access to home 
health agencies by expanding the number of Medicare-certified home health 
agencies and expanding the capacity of the existing agencies to serve the 
aged, ill, and disabled. 



301 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 
PROGRAM: NATIONAL HEALTH SERVICE CORPS (NHSC) 
TELEPHONE: 301-443-1470 
DESCRIPTION: 

The purpose of the Corps is to Improve the capacity to provide health 
manpower to areas with the greatest need and demand for health care and 
which have been unable to attract providers of primary care services. To 
accomplish this, the NHSC recruits and places physicians and other 
professionals in HMSAs. The NHSC was to be, and is, a joint community 
and Federal Government project. Through the NHSC, the Government 
provides and pays medical, dental, and other health personnel while the 
community provides a medical facility and support personnel and assumes 
responsibility for managing the practice. 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 

PROGRAM: NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM 

TELEPHONE: 301-443-3744 

DESCRIPTION: 

These scholarships are awarded to U.S. citizens enrolled or accepted for 
enrollment as full-time students in accredited U.S. schools of allopathic 
or osteopathic medicine, dentistry, and other health disciplines needed 
for the mission of the NHSC. These scholarships include a monthly living 
stipend and payment of school tuition and fees. Each year of scholarship 
support incurs a year of Federal service obligation. The minimum service 
obligation is 2 years . 

The NHSC places full-time primary health care practitioners in selected 
Federally-designated Health Manpower Shortage Areas of the U.S. 
Virtually all of these practitioners owe service obligations of 2 to 4 
years due to their participation in the NHSC Scholarship program. 
Service may be performed as a Federal employee or, under specified 
conditions, as a private practitioner. Besides placement under NHSC 
auspices, service may also include placement at the health care 
facilities of the Indian Health Service or the Federal Bureau of Prisons. 



302 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 

PROGRAM: HANSEN'S DISEASE PROGRAM 

TELEPHONE: 301-443-6910 

DESCRIPTION: 

The purpose of this program is to identify/detect and provide total care, 
diagnosis, and treatment for people in the U.S. with this disease. 

The National Hansen's Disease Center in Carville, LA, provides these 
services to 130-150 inpatients at any one time plus numerous patients on 
an outpatient basis. The Center provides advanced and rehabilitative 
treatment and presently has approximately 50 lifetime residents. 

Additionally, the program provides 12 contract sites (which are located 
where the old PHS hospitals were) which provide outpatient and inpatient 
services to populations of persons with this disease. 

The program maintains a registry of persons with this disease. 



303 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 

PROGRAM: HEALTH CAREERS OPPORTUNITY PROGRAM/ DIVISION OF DISADVANTAGED 
ASSISTANCE/BUREAU OF HEALTH PROFESSIONS 

TELEPHONE: 301-443-2100 

DESCRIPTION: 

Section 787 of the PHS Act, as amended by the Omnibus Budget Reconciliation 
Act of 1981, P.L. 97-35, authorizes the Secretary to make grants to schools 
of medicine, osteopathy, public health, dentistry, veterinary medicine, 
optometry, pharmacy, podiatry, and allied health, and other public or 
private nonprofit health or educational entities to carry out programs which 
assist individuals from disadvantaged backgrounds to enter and graduate from 
health professions schools. 

The 1981 amendments require that at least 80 percent of the funds 
appropriated in any fiscal year must be obligated for grants or contracts to 
institutions of higher education. Also, the 1981 amendments permit the 
obligation of no more than five percent of the funds appropriated In any 
fiscal year for awards for projects having information dissemination as 
their primary purpose. 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 

PROGRAM: ADVANCED FINANCIAL DISTRESS/OFFICE OF PROGRAM SUPPORT/BUREAU OF 
HEALTH PROFESSIONS 

TELEPHONE: 301-443-6880 

DESCRIPTION: 

This program provides Federal assistance to health professions schools to 
meet operating costs of those schools that are in serious financial straits, 
to meet pressing accreditation requirements, or to carry out operational, 
managerial, or financial reforms. 



304 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 

PROGRAM: NURSING SPECIAL PROJECT GRANTS/DIVISION OF NURSING/BUREAU OF 
HEALTH PROFESSIONS 

TELEPHONE: 301-443-6193 

DESCRIPTION: 

This program Is designed to improve the quality and availability of nurse 
training opportunities through providing grant and contract support to 
public and nonprofit private schools of nursing and other entities. Not 
less than 20 percent of the funds appropriated will be used to increase the 
supply or improve the distribution by geographic area or specialty group of 
adequately trained nursing personnel. Nursing education opportunities for 
individuals from disadvantaged backgrounds will be increased by obligating 
not less than 20 percent of the available funds for this purpose. Ten 
percent of the funds will be used to support projects to upgrade the skills 
of LPNs and other paraprofessional nursing personnel. Additional projects 
will provide continuing education for practicing nurses or retraining 
programs for inactive nurses. 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 

PROGRAM: PROFESSIONAL NURSE TRAINEESHIP GRANT PROGRAM/DIVISION OF NURSING/ 
BUREAU OF HEALTH PROFESSIONS 

TELEPHONE: 301-443-6333 

DESCRIPTION: 

This program provides support to eligible public or nonprofit institutions 
who in turn award traineeship grants to professional nurses receiving 
advanced educational preparation for leadership positions. These 
traineeships prepare the professional nurse to teach in various fields of 
nursing, to serve in administrative or supervisory capacities, to serve as 
nurse practitioners or to serve In other professional nurse specialties, 
with special consideration given to nurse practitioner training programs. 



305 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 

PROGRAM: AREA HEALTH EDUCATION CENTERS (AHEC) /DIVISION OF 
MEDICINE/BUREAU OF HEALTH PROFESSIONS 

TELEPHONE: 301-443-6190 

DESCRIPTION: 

This program addresses problems of geographic maldistribution and 
overspecialization of health professionals through changes in the 
traditional pattern of health professions education. The program 
provides funds to medical and osteopathic schools for the purposes of 
decentralizing education by having portions of training provided in 
primary medical personnel shortage areas and by improving the 
coordination and use of existing resources. Thus, the AHEC concept is a 
regionalized systems approach to the development of needed health 
personnel. AHEC is one of several Federal programs aimed at making 
health care accessible at a reasonable cost. 

Current program efforts emphasize relieving health personnel shortages. 
Awards are for planning, development, operation, and special 
initiatives. Projects include emphasis on health promotion, programs for 
the disadvantaged, and coordinating Federal efforts with agencies such as 
the National Health Service Corps and health planning entities. 
Continuing education for health professionals is made available and 
provides complementary necessary backup educational support systems for 
the National Health Service Corps. Cost containment is encouraged by 
better organization of resources. 



306 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 

PROGRAM: HEALTH PROFESSIONS ANALYTICAL STUDIES AND REPORTS/ OFF ICE OF DATA 
ANALYSIS AND MANAGEMENT /BUREAU OF HEALTH PROFESSIONS 

TELEPHONE: 301-443-6936 

DESCRIPTION: 

This program provides up-to-date, carefully analyzed information on health 
professions supply, geographic and specialty distribution and utilization to 
the President, the Congress, the Department, the public, and other 
organizations. This information is essential to the development and 
evaluation of national health policy decisions to assure that an adequate 
supply of practicing health professionals (accessible and equitably 
distributed) is available. The health fields encompass over 6 million 
workers and 1,700 health professions schools enrolling almost 400,000 
students. 

This authority directs the Secretary of HHS to carry out a wide variety of 
analytical activities through this program, including: 

- development of reliable, impartial health professions data and analyses 
to assist national health policy, development and evaluation; 

- monitoring and analyzing developments and changes in the health 
professions and the type, amount, and cost of the care they provide; 

- projection of supply and requirements for physicians and other health 
personnel by professional specialty and by geographic location; 

- preparation of required reports to the President and the Congress. 

In addition, this program is charged with the responsibility for properly 
identifying, designating, and reviewing health professions shortage areas 
throughout the U.S., in coordination with the States, local communities, and 
professional groups. 

The desired result of this program is to identify achievements, to 
anticipate potential health professions problems, to provide useful analysis 
of current complex health professions issues, and to provide practical 
assessments of the impacts of alternative health professions policies on the 
content, cost, and configuration and quality of care delivery resources. 



307 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 

PROGRAM: NURSE MIDWIFERY OFFICE 

TELEPHONE: 602-871-5888 

DESCRIPTION: 

This program is one component of an interdisciplinary MHC team providing 
comprehensive health care to Native American and Alaskan Native women and 
infants. Certified Nurse Midwives (CNM) are stationed at 14 service units 
located in 6 IHS areas. Eleven of the service units are located in remote 
geographical areas where there are no other, or very limited, health 
resources available. 

Services provided by CNMs include a full range of maternal services 
including antepartum, intrapartum, postpartum, family planning, minor 
gynecological and preventive health surveillance activities. The initial 
physical assessment of the newborn, following delivery, and daily 
assessment/teaching during the postpartum period are part of the CNM 
responsibility. 

Major emphasis is given to teaching and counseling activities. Educational 
efforts are directed towards clients either individually or in groups and in 
the community. CNMs also participate in education of health professionals 
by supervising clinical preceptorships of student nurse midwives, medical 
students, general medical officers (who have limited OB experience), and 
others. 

During FY 1984 a total of 53,857 ambulatory services were provided to this 
patient population by 25.8 FTE CNMs. In addition, CNMs managed the 
intrapartum care of 35 percent (2,558) of the total deliveries occurring at 
these service sites. CNM co-management of high risk physician delivered 
patients were provided to a significant number of patients. 



308 



HEALTH RESOURCES AND SERVICES ADMINISTRATION 

PROGRAM: CONTRACT HEALTH SERVICE (CHS) 

TELEPHONE: 301-443-2694 

DESCRIPTION: 

The purpose of this program is to purchase medical care services, 
coincidental equipment, and supplies for direct patient care, to 
supplement and complement other health care resources available to 
eligible Indian people. CHS is utilized in situations where: (1) no IHS 
direct care facility exists; (2) the direct care element is incapable of 
providing required emergency and/or specialty care; (3) the direct care 
element has an overflow of medical care workload; and (4) supplementation 
of alternate resources such as Medicare, is required to provide 
comprehensive care to eligible Indian people. 

The CHS funds may be expended to purchase services delivered to an 
individual physically present in an IHS facility. Cost must not be 
incurred for patients admitted by a non-IHS physician (or other health 
care provider) practicing outside the rule and by-laws of an IHS 
facility, unless the patient is eligible under 42 CFR 36.23. 



309 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: ANIMAL RESOURCES PROGRAM/DIVISION OF RESEARCH RESOURCES (DRR) 

TELEPHONE: 301-496-5507 

DESCRIPTION: 

The goal of this program is to support resource projects that enable 
scientists to obtain and use animals effectively in health-related 
research. Special attention is given to those animal resource activities 
that support the missions of the various NIH components. The objectives are 
accomplished through the Regional Primate Research Centers Program and the 
Laboratory Animal Sciences Program. Specifically: 

• Regional Primate Research Centers Program 

The original objective was to meet a recognized need for suitable 
facilities and appropriate research environments where biomedical 
research employing the nonhuman primate could be best conducted. 

• Laboratory Animal Sciences Program 

This program assists institutions in developing and improving animal 
resources for biomedical research and training through the award of 
research and resource grants. 



310 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: BIOMEDICAL RESEARCH SUPPORT PROGRAM/ DIVISION OF RESEARCH RESOURCES 
(DRR) 

TELEPHONE: 301-496-5507 

DESCRIPTION: 

The Biomedical Research Support (BRS) Program consists of three distinct 
activities: the Biomedical Research Support Grant (BRSG) Program, the BRS 
Shared Instrumentation Grant (SIG) Program, and the Minority High School 
Student Research Apprentice Program (RAP). The authorizing legislation 
allows NIH to fund research grants for general support to strengthen 
institutional research in sciences related to health. 

• Biomedical Research Support Grants (BRSG) 

The objective of this activity is to strengthen and enhance the research 
environment of institutions heavily engaged in health-related research 
through the use of flexible funds and local decision-making, which 
enable them to conduct their biomedical research programs more 
efficiently and effectively. 

• BRS Shared Instrumentation Grant (SIG) Program 

The overall SIG Program objective is to make available to institutions 
major research instrumentation on a shared-use basis for groups of 
NIH-funded investigators. 

• Minority High School Student Research Apprentice Program (RAP) 

The purpose of the apprentice program is to stimulate minority high 
school students to seek careers in science. 



311 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: GENERAL CLINICAL RESEARCH CENTERS PROGRAM/ DIVISION OF RESEARCH 
RESOURCES (DRR) 

TELEPHONE: 301-496-5507 

DESCRIPTION: 

The program provides resources for 76 General Clinical Research Centers 
where highly qualified investigators have the opportunity to advance the 
knowledge of medicine in a clinical setting. 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: BIOMEDICAL RESEARCH TECHNOLOGY PROGRAM/ DI VI SON OF RESEARCH 
RESOURCES (DRR) 

TELEPHONE: 301-496-5507 

DESCRIPTION: 

This program now places greater emphasis on regional and national sharing of 
resources. Today, it focuses on applications of knowledge engineering, 
information technology, biomedical engineering and digital technology for 
biomedical and clinical research programs, and technologies for the study of 
biomolecular and cellular structure and function. 



312 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: MINORITY ACCESS TO RESEARCH CAREERS (MARC) PROGRAM 

TELEPHONE: 301-496-7941 

DESCRIPTION: 

This program is a research training program for faculty members and students 
at minority institutions having health-related research activities. It is 
composed of a predoctoral and postdoctoral faculty fellowship program, a 
visiting scientist program, an honors undergraduate research training 
program, and an individual predoctoral fellowship program. 

The central goal of this program remains that of increasing the number of 
highly qualified minority group biomedical scientists. To accomplish this 
objective, a marked increase in the enrollment of minority group students as 
Ph.D. candidates in major universities nationwide must first be achieved. 
Sound preparation of even the most outstanding students during their 
undergraduate years must precede their successful entrance into graduate 
school. The MARC Program, through its MARC Honors Undergraduate Research 
Training Program, focuses on strengthening the traditional minority 
institutions toward developing a pool of highly qualified predoctoral 
candidates . 



313 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: MINORITY BIOMEDICAL RESEARCH SUPPORT PROGRAM/DIVISION OF RESEARCH 
RESOURCES (DRR) 

TELEPHONE: 301-496-5507 

DESCRIPTION: 

The objective of this program is to increase the number and quality of 
minority biomedical research scientists. This program accomplishes its 
objectives by: strengthening the capability of eligible institutions to 
support the conduct of quality research in the health sciences; supporting 
faculty at eligible institutions as they pursue biomedical research 
interests and capabilities; and supporting minority students engaged in 
research projects at the undergraduate and graduate levels to motivate and 
prepare them for careers in biomedical research. 



314 



NATIONAL INSTITUTES OF HEALTH 
PROGRAM: EPIDEMIOLOGY RESEARCH PROGRAM/ NATIONAL CANCER INSTITUTE (NCI) 
TELEPHONE: 301-496-3505 
DESCRIPTION: 
Activities of interest include: 

• The contract which supports epidemiologic studies of cancer among 
Alaskan natives (supported jointly with CDC's Bureau of Alaskan 
Activities) terminated at the end of FY 1984. A new initiative in FY 
1985 and FY 1986 will include a national epidemiologic investigation of 
four cancers dominant in Blacks — esophageal, prostate, pancreas, and 
multiple myeloma to determine why these cancers occur more frequently 
among Blacks. 

• A major new effort is being launched to identify the risk factors for 
cervical cancer in Latin American women, which should be relevant to 
this same disease problem in American-Hispanic women. 

• Added new sites to SEER registry; i.e., the New Jersey Department of 
Health. 

• A major new population-based, case-control study for tumors, which are 
excessive in Blacks, with the specific goal for identifying risk factors 
for the disease in Whites and Blacks and assessing the amount of 
difference will be launched. New focus will concentrate on an 
evaluation of the risk factors for cancers of the uterine cervix, 
another malignancy which is particularly excessive among Black and 
Hispanic women. 

• Recently a case-control study of esophageal cancer among Blacks in 
Washington, D.C. was conducted. The study confirmed that a substantial 
amount of the disease could be attributed to cigarette smoking and 
excessive alcohol use. The findings in this study are currently being 
pursued in a study of esophageal cancers in Blacks in South Carolina and 
Florida. 



315 



NATIONAL INSTITUTES OF HEALTH 



PROGRAM: CHEMICAL AND PHYSICAL CARCINOGENESIS RESEARCH PROGRAM (CPCRP)/ 
NATIONAL CANCER INSTITUTE 

TELEPHONE: 301-496-3505 

DESCRIPTION: 

This program conducts research concerned with the occurrence and the 
inhibition of cancer caused or promoted by chemical or physical agents 
acting separately or together, or in combination with biological agents. 
Research supported here places emphasis on environmental carcinogenesis, 
mechanisms of action of chemical and physical carcinogens, the role of 
DNA repair and damage, the role of tumor promoters, hormones, etc. 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: BIOLOGICAL CARCINOGENESIS RESEARCH PROGRAM (BCRP) /NATIONAL 
CANCER INSTITUTE 

TELEPHONE: 301-496-3505 

DESCRIPTION: 

The aim of this research program is to provide valuable insights into the 
mechanisms of vital carcinogenesis and the means by which the transformation 
of cells from the normal to the malignant state occurs. An example of 
research conducted in this area is studies dealing with Acquired Immuno- 
deficiency Syndrome (AIDS) and Kaposi Sarcoma. 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: NUTRITION RESEARCH PROGRAM (NRP) /NATIONAL CANCER INSTITUTE (NCI) 

TELEPHONE: 301-496-3505 

DESCRIPTION: 

Nutrition research efforts seek to identify foodstuffs containing naturally 
occurring mutagens and carcinogens and their characterization and seeks 
to identify a wide variety of chemically diverse substances in food that 
can inhibit the initiation, promotion, and progression of cancer. 



316 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: TUMOR BIOLOGY RESEARCH PROGRAM/ NATIONAL CANCER INSTITUTE (NCI) 

TELEPHONE: 301-496-3505 

DESCRIPTION: 

This program supports a broad spectrum of basic biological research to 
determine what cellular and molecular factors distinguish cancer cells from 
normal, healthy cells and tissues. The supposition is that knowledge of 
these properties and processes will help us learn how to manipulate or 
change the biological signals responsible for the aberrant behavior of 
cancer cells. Ultimately, this should result in more effective methods for 
the diagnosis, treatment, and management of cancer victims. Emphasis is on 
understanding the basic biochemical mechanisms involved in growth control, 
cancer cell invasion, and cancer cell differentiation. 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: IMMUNOLOGY RESEARCH PROGRAM/NATIONAL CANCER INSTITUTE (NCI) 

TELEPHONE: 301-496-3505 

DESCRIPTION: 

The immune system provides a defense mechanism for the elimination of 
foreign, non-self substances from the body. The cancer cell, having new or 
non-self characteristics, should be the target of this surveillance 
mechanism and should thus be prevented from establishing a tumor. This 
program supports research associated with this phenomena. 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: DIAGNOSTIC RESEARCH PROGRAM (DRP) /NATIONAL CANCER INSTITUTE (NCI) 

TELEPHONE: 301-496-3505 

DESCRIPTION: 

Supports research leading to the development of instrumentation and 
methodology to improve the diagnosis and management of cancer. 



317 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: PRECLINICAL TREATMENT RESEARCH PROGRAM (PTRP) /NATIONAL CANCER 
INSTITUTE (NCI) 

TELEPHONE: 301-496-3505 

DESCRIPTION: 

Supports research in areas of biochemistry, pharmacology, molecular biology, 
chemistry, and radiobiology to enhance fundamental understanding of 
treatment at the cellular and molecular level in order to better transfer 
effective clinical treatment applications. 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: CLINICAL TREATMENT RESEARCH PROGRAM (CTRP) /NATIONAL CANCER 
INSTITUTE (NCI) 

TELEPHONE: 301-496-3505 

DESCRIPTION: 

Investigates the use of chemotherapy, surgery, radiotherapy, and 
immunotherapy (either alone or in combination) to obtain optimal treatment. 
Primary supporter of clinical trials research within the NCI. 

Increased emphasis will be given to expansion of clinical trials with 
emphasis directed towards underserved populations to improve ability to 
access latest and most effective cancer treatments. 

In conjunction with Comprehensive (Cooperative) Minority Biomedical Program 
efforts, has provided supplemental support to cooperative group grants so 
that minority patient accrual can be increased. 



318 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: REHABILITATION RESEARCH PROGRAM (RRP)/NATIONAL CANCER INSTITUTE 
(NCI) 

TELEPHONE: 301-496-3505 

DESCRIPTION: 

This program seeks to counsel cancer patients, studies prosthetic and 
physical restorative measures, pain control, continuing care, and 
rehabilitative nutrition. 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: COMPREHENSIVE MINORITY BIOMEDICAL PROGRAM (CMBP) /NATIONAL CANCER 
INSTITUTE (NCI) 

TELEPHONE: 301-496-3505 

DESCRIPTION: 

Major activities of interest include: 

The Minority Investigator Supplement (MIS) is an initiative designed to 
encourage participation in cancer-related research by members of 
under rep resented ethnic American minorities by providing supplemental funds 
to NCI grantees to include minority researchers. 

The Satellite Program is an inter-divisional special initiative between 
several NCI divisions that seeks to increase the number of minority patients 
involved in NCI-supported clinical trials treatment protocols. Thus, 
improve survival and cure rates in minority cancer patients. This is being 
accomplished through supplemental grants to cooperative group grants. 

"Cancer in Minorities" is the theme for a conference to be held in 
Washington, D.C., in conjunction with Cancer Prevention and Control. 

Staff visits are made regularly to institutions that may have affiliate 
hospitals to promote the cancer research grant mechanism and to access 
minority physicians, patients, and others as resources in response to 
concerns about cancer care, information, and education. 

This program provides support to mission-related cancer research projects 
through MBRS, DRR, and the MARC, NIGMS to broaden participation by 
minorities in cancer-related research and training activities and to enhance 
the effectiveness of programs in cancer medicine and cancer control in 
reaching the minority community and other historically underserved segments 
of the population. This is accomplished through co-funding agreements and 
special initiatives. 



319 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: CANCER CONTROL PROGRAM (CCP) /NATIONAL CANCER INSTITUTE (NCI) 

TELEPHONE: 301-496-3505 

DESCRIPTION: 

Major activities include: 

In 1985 two RFAs will solicit applications for smoking cessation programs 
for Blacks and Hispanics to reduce the number of smokers in these 
populations. This will be continued in 1986. 

Minority-oriented grants will be funded in 1985 for the prevention of 
preventable mortality . These grants will study reasons why deaths occur 
from those cancers for which early detection and/or effective treatment 
technology already exist, and stimulate the development of intervention 
programs to eliminate those causes. The sites to be targeted include: for 
Blacks - cancers of the lung, breast, prostate, colon-rectal, and cancer of 
the cervix; for Hispanics - cancers of the cervix and lung; for Orientals - 
cancers of the stomach and esophagus. 

A new program of cooperative agreements with state and local health 
departments is being launched to improve the technical capability of such 
agencies to conduct prevention and control initiatives. Emphasis will be 
placed on areas with a high concentration of minorities. 

A Cancer Control Science Association Program is being developed to provide 
interested scientists with an intensive education exposure to the current 
opportunities in cancer control science. Efforts will be made to recruit 
minority scientists here. 



320 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: RETINAL AND CHOROIDAL DISEASES BRANCH /NATIONAL EYE INSTITUTE (NEI) 

TELEPHONE: 301-496-4308 

DESCRIPTION: 

Plans and conducts the Institute's research grants, training grants, 
fellowships, and career award programs in the vision sciences of retinal and 
choroidal disorders and related areas as the mission of the Institute 
indicates. 

This program is currently funding a study to Investigate synchysis senilis 
and posterior vitreous detachment in eyes of Blacks and compare these 
changes with those in Whites in an attempt to explain the significantly 
lower incidence of rhegmatogenous retinal detachment in Blacks. 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: STRABISMUS, AMBLYOPIA, AND VISUAL PROCESSING/NATIONAL EYE 
INSTITUTE (NEI) 

TELEPHONE: 301-496-4308 

DESCRIPTION: 

Plans and conducts the Institute's research grants, training grants, 
fellowships, and career award programs in the vision sciences of 
sensory-motor disorders, rehabilitation, and related areas as the mission of 
the Institute indicates. 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: INTRAMURAL RESEARCH PROGRAM/NATIONAL EYE INSTITUTE (NEI) 

TELEPHONE: 301-496-4308 

DESCRIPTION: 

Plans and conducts the Institute's laboratory and clinical research program, 
which encompasses five major disease areas: retinal and choroidal diseases, 
corneal diseases, cataract, glaucoma, and strabismus, amblyopia, and visual 
processing, to ensure maximum utilization of available resources in the 
attainment of Institute objectives. 



321 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: ANTERIOR SEGMENT DISEASES BRANCH /NATIONAL EYE INSTITUTE (NEI) 

TELEPHONE: 301-496-4308 

DESCRIPTION: 

Plans and conducts the Institute's research grants, training grants, 
fellowships, and career award programs in the basic and clinical sciences 
relating to corneal diseases, cataract, and glaucoma, and in other related 
areas as the mission of the Institute indicates. 

The NEI has awarded a grant which has the general objectives of verifying 
and determining the source of this reported greatly increased prevalence of 
glaucomatous blinding in Blacks. This study will measure the prevalence of 
glaucoma in Whites and Blacks in east Baltimore and based on the cases 
ascertained in the prevalence survey, identify and measure potential risk 
factors in cases and controls stratified by race. 

A study is being funded which was designed as a prospective evaluation of a 
multivariate estimate of risk in a selected population of subjects with 
ocular hypertension. Approximately 20 percent of the study population is 
Black, and therefore important information regarding the utility of this 
estimate of risk in Blacks should be gathered. 



322 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: HEART AND VASCULAR DISEASES PROGRAM/ DIVISION OF EPIDEMIOLOGY AND 
CLINICAL APPLICATIONS (DECA) /NATIONAL HEART, LUNG, AND BLOOD 
INSTITUTE (NHLBI) 

TELEPHONE: 301-496-3620 

DESCRIPTION: 

Activities of relevance include: 

The NHLBI-HRSA Community Health Center Project for High Blood Pressure 
Control . This project conducts, documents, and evaluates high blood 
pressure control efforts in four underserved communities (two are 
predominantly Black, rural populations; one is a predominantly Black, urban 
population; and the fourth is a predominantly Hispanic, rural population). 
The project was started in 1981 and is modeled on the stepped-care approach 
of the Hypertension Detection and Follow-Up Program and is responsive to the 
recommendation made by the National Black Health Providers' Task Force on 
High Blood Pressure Education and Control that a community organization 
approach may be essential to successful blood pressure control. 

Biobehavioral Factors affecting Hypertension in Blacks . This portfolio of 
seven grants to geographically diverse research institutions was initiated 
for a three year period in 1983 to investigate the interaction of behavior 
with physiology in the etiology of hypertension, a notable health hazard for 
Blacks . 

The Development of Obesity in Young Black and White Females . This long-term 
prospective study of preadolescent girls, to start in 1985, will investigate 
those factors such as psychosocial, family, physical activity, dietary, and 
socioeconomic that may determine black/white differences in development of 
obesity, which is more prevalent in black women than in white women. 



323 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: EPIDEMIOLOGY AND BIOMETRY PROGRAM/DIVISION OF EPIDEMIOLOGY AND 
CLINICAL APPLICATIONS (DECA) /NATIONAL HEART, LUNG, AND BLOOD 
INSTITUTE (NHLBI) 

TELEPHONE: 301-496-2327 

DESCRIPTION: 

Activities of relevance include: 

• The Longitudinal Studies of Coronary Heart Disease Risk Factors in 
Young Adults: CARDIA . This prospective, epidemiological investiga- 
tion of the precursors and determinants of CHD risk factors and their 
evolution will study 5,100 participants, 50% of whom will be Black. 
This biracial cohort, geographically diverse, will comprise young men 
and women, ages 18-30 years, who will be examined at intervals to 
quantify changes in lifestyle and risk factor profiles that occur 
over time. 

• The Community and Cohort Surveillance Program: CCSP . This is a 
large, long-term program that will measure associations of established 
and suspected coronary heart disease (CHD) risk factors with both 
atherosclerosis and new CHD events in four diverse communities, and 
compare the communities with respect to risk factors, medical care, 
atherosclerosis and CHD incidence. The project will include sur- 
veillance of about 80,000 men and women in each community and repeated 
examinations of representative cohorts of about 4,000 persons in each 
community. One cohort will be predominantly Black and the other three 
will reflect the ethnic composition of the communities in which they 
live. Surveillance will be achieved through monitoring hospital 
records and death certificates. 



324 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: LUNG DISEASES PROGRAM/DIVISION OF LUNG DISEASES (DLD)/ NATIONAL 
HEART, LUNG, AND BLOOD INSTITUTE (NHLBI) 

TELEPHONE: 301-496-7208 

DESCRIPTION: 

The lung diseases program is concerned with six major areas related to 
respiratory disorders: structure and function of the respiratory system, 
pediatric pulmonary diseases, and chronic obstructive pulmonary diseases, 
occupational and immunologic lung diseases, pulmonary vascular diseases, and 
respiratory failure. 

Activities of relevance include: 

Respiratory Diseases in Hispanics : This study is being directed primarily 
towards describing the prevalence of respiratory symptoms and diseases in 
Hispanics, determining risk factors for respiratory diseases in this 
population, and developing predictive equations for respiratory parameters 
in Hispanics. 

Minority Summer Research Program in Pulmonary Research . The objective of 
this program is to encourage minority school faculty members and graduate 
students to develop interest and skills in research in pulmonary disease at 
established Pulmonary Training Centers. 



325 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: BLOOD DISEASES AND RESOURCES PROGRAM (DBDR)/ NATIONAL HEART, LUNG, 
AND BLOOD INSTITUTE (NHLBI) 

TELEPHONE: 301-496-6931 

DESCRIPTION: 

The Blood Disease and Blood Resources Program plans and directs the 
Institute's research grant, contract, and training programs in blood disease 
and resources. The four major areas of responsibility are: bleeding and 
clotting disorders, disorders of the red blood cell, sickle cell disease and 
blood resources. 

Major activities include: 

Comprehensive Sickle Cell Disease Centers . The purpose of the Sickle Cell 
Disease Centers is to focus resources, facilities and work force in a 
coordinated approach to sickle cell disease. This approach Includes a 
combination of research and demonstration service activities designed to 
bridge the gap between these two disciplines. Programs of the Sickle Cell 
Disease Centers include basic or fundamental research, clinical research, 
clinical application, clinical trials, professional and paraprofessional 
education programs, public education, screening, counseling and related 
activities. Currently there are ten centers located throughout the country. 

Cooperate Study of Sickle Cell Disease . A large-scale national cooperative 
study involving 23 institutions and 3,535 patients to investigate the 
clinical course or natural history of sickle cell disease is in its 7th 
year. This cooperative study should expand our understanding of the 
clinical aspects and management of sickle cell disease and provide baseline 
information for future research, including evaluation of antisickling agents. 

A prospective multi-center cooperative study has been initiated to study the 
relation of immune function changes to the use of blood and blood products. 
Among the study cohorts, heavily transfused sickle cell disease patients 
will be entered and prospectively evaluated during the duration of the study. 



326 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: COMPANION ISSUES/RESEARCH TRAINING AND DEVELOPMENT/NATIONAL HEART, 
LUNG, AND BLOOD INSTITUTE (NHLBI) 

TELEPHONE: 301-496-1763 

DESCRIPTION: 

NHLBI initiated a task force with the Association of Minority Health 
Professions Schools to explore how the Institute could contribute to the 
development and strengthening of the biomedical research base at minority 
health professions school. As a result the NHLBI Minority Investigators and 
Minority Institutional Research Plan was developed consisting of four 
initiatives: Minority School Faculty Development Award; Minority 
Institutional Research Training Program; Research Fellow Program for 
Investigators at Minority Institutions; and the NHLBI Visiting Professor 
Program. 



327 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: OFFICE OF PREVENTION, EDUCATION AND CONTROL (OPEC) /NATIONAL 
HEART, LUNG, AND BLOOD INSTITUTE (NHLBI) 

TELEPHONE: 301-496-1763 

DESCRIPTION: 

Activities of relevance include: 

Ad Hoc Committee on High Blood Pressure Control in Minority Populations . 
The mission of this committee has been expanded to include cholesterol 
and smoking. 

Media Campaigns . There have been PSAs targeted to minority populations. 

Reports Completed . Two reports of relevance are: "Guide to Church 
Programs for High Blood Pressure Control" and "Review of Media Approaches 
for Reaching Black Audiences . " 

Open Airway — Respiro Abierto . This is the first educational module for 
asthma self-management targeted to Black and Hispanic patients at 
Columbia University. 



328 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: BEHAVIORAL SCIENCES RESEARCH/NATIONAL INSTITUTE ON AGING (NIA) 

TELEPHONE: 301-496-3136 

DESCRIPTION: 

Research in variability among racial and ethnic groups is important. It is 
known that individuals grow up and grow old under varying conditions and 
that there is social, cultural, and individual variability in aging to be 
found and understood. In general, life expectancy, health status, and 
environmental influences have been less favorable for minorities than for 
the majority population. BSR/NIA has issued a standing program announcement 
directed to social and behavioral research in minority aging. 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: SYSTOLIC HYPERTENSION IN THE ELDERLY/NATIONAL INSTITUTE ON AGING 
(NIA) 

TELEPHONE: 301-496-4996 

DESCRIPTION: 

The Systolic Hypertension in the Elderly Program (SHEP), is a multicenter 
study of the efficacy of antihypertensive treatment in elderly patients with 
isolated systolic hypertension (ISH). The primary objective of this study 
is to determine whether the long term administration of antihypertensive 
therapy for the treatment of isolated systolic hypertension in elderly 
persons reduces the incidence of combined fatal and nonfatal stroke. 



329 



NATIONAL INSTITUTES OF HEALTH 
PROGRAM: PUBLIC INFORMATION OFFICE/NATIONAL INSTITUTE ON AGING (NIA) 
TELEPHONE: 301-496-1752 
DESCRIPTION: 
Major activities in this area are provided below: 

• Smithsonian Folklife Festival — This is a joint effort between the NIA 
and the Smithsonian folklore specialists to highlight the experiences of 
very old Americans, particularly Black Americans. 

• Market research study of aging and health promotion — The goal of this 
project was to determine how interested older people (specifically 
minority elderly) are in acquiring health information and whether they 
want to, and are able to, make lifestyle changes. 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: EPIDEMIOLOGY, DEMOGRAPHY, AND BIOMETRY PROGRAM/ NATIONAL INSTITUTE 
ON AGING (NIA) 

TELEPHONE: 301-496-1178 

DESCRIPTION: 



Major projects in this area are: 

The Center for Aging and Human Development at Duke University is conducting 
a study of an elderly population of 4,500 persons 65 years of age or older 
of which at least 50 percent will be Black. The purpose of this study is to 
investigate the influence of social, environmental, behavioral, and economic 
forces on the mortality, morbidity, and utilization of health services in 
the study population, 
late FY 1984. 



Funding for this study of a Black population began in 



A five year contract was awarded to Yale University in June of 1980 to 
conduct a prospective study of the elderly living in New Haven, 
Connecticut. This midsize city is predominantly a low to middle income 
community of mixed racial background (21 percent Black). The purpose of 
this study is to investigate the influence of social, environmental, 
behavioral, and economic forces on the mortality, morbidity, and utilization 
of health services in the study population. 



330 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: GERONTOLOGY RESEARCH PROGRAM/ NATIONAL INSTITUTE ON AGING (NIA) 

TELEPHONE: 301-955-1705 

DESCRIPTION: 

Investigators in the Stress and Coping Section have published a study 
utilizing data on non-whites from the earlier NHANES data collected during 
the period 1971-1974. These analyses on minority individuals investigated 
the relations among depression, general well-being, and chest pain 
complaints in the NHANES sample and replicated findings from a similar 
random sample of White subjects. It is planned to repeat these analyses 
using the NHANES followup data. 



331 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: MICROBIOLOGY AND INFECTIOUS DISEASES PROGRAM/OFFICE OF PROGRAM 

PLANNING AND EVALUATION (OPPE) /NATIONAL INSTITUTE OF ALLERGY AND 
INFECTIOUS DISEASES (NIAID) 

TELEPHONE: 301-496-6752 

DESCRIPTION: 

This program funds research in the following areas: 

Respiratory Infections 

Hepatitis 

Sexually Transmitted Diseases 

Hospital-Associated Infections 

Parasitic Diseases 

Enteric Diseases 

Bacterial Vaccines 

Antibiotic Trials 

Antiviral Substances 

Molecular Biology 

Additionally, the Institute' s International Biomedical Research Program 
involves both grants and contracts to promote scientific research on 
diseases of great importance to the health of the people in developing 
countries of the world and to improve their quality of life. 



332 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: IMMUNOLOGY, ALLERGIC AND IMMUNOLOGIC DISEASES PROGRAM/ OFF ICE OF 
PROGRAM PLANNING AND EVALUATION (OPPE) /NATIONAL INSTITUTE OF 
ALLERGY AND INFECTIOUS DISEASES (NIAID) 

TELEPHONE: 301-496-6752 

DESCRIPTION: 

This program focuses on the Immune system as it functions in the maintenance 
of health and as it malfunctions in the production of disease. It 
encompasses both basic and clinical research. 

Basic research is conducted under two segments : Immunology and 
Immunochemistry, and Genetics and Transplantation Biology. Clinical 
research is supported in two areas: asthma and allergic diseases, and 
clinical immunology and immunopathology. NIAID' s approach integrates 
anatomy, physiology, cell biology, and immunochemistry. 



333 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: ARTHRITIS, MUSCULOSKELETAL AND SKIN DISEASES /NATIONAL INSTITUTE OF 
ARTHRITIS, DIABETES, AND DIGESTIVE AND KIDNEY DISEASES (NIADDK) 

TELEPHONE: 301-496-6623 

DESCRIPTION: 

• Lupus Erythematosus 

The NIADDK is supporting numerous diverse research projects on the cause 
and treatment of lupus. 

• Vitiligo 

The NIADDK has recently launched a major research initiative to find 
improved interventions to be used in the treatment of Blacks suffering 
from vitiligo. 

• Rheumatoid Arthritis 

The NIADDK is supporting several educational and community health 
services projects for minorities through its Multipurpose Arthritis 
Centers. One study will examine the relationship between chronically 
ill people of various ethnic diverse backgrounds, particularly Hispanics 
and Blacks, and the scientific health care system. Another study will 
examine the differences among three ethnic groups (Blacks, Hispanics, 
and Whites of European origin) in their beliefs about arthritis, use of 
medical treatment for chronic joint symptoms, and patterns of self care 
and home remedies. A third project will develop a method of arthritis 
patient education targeted to Black and Hispanic adults with low 
literacy. It is intended that the entire project, consisting of a 
patient education program and associated manuals and evaluation methods, 
will be combined into a transportable project for use nationally. 



334 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: DIABETES/NATIONAL INSTITUTE OF ARTHRITIS, DIABETES, AND DIGESTIVE 
AND KIDNEY DISEASES (NIADDK) 

TELEPHONE: 301-496-6623 

DESCRIPTION: 

Predisposing factors for diabetes and diabetic complications are thought to 
include heritage, genetic background, increased levels of obesity and 
sedentary activity, diet and nutritional preferences, life style and 
socioeconomic status. These and other factors can vary widely in minority 
populations. The degree to which any or all of these factors contributes to 
the risk of diabetes is as yet unknown. 

The diabetes programs in the DEMD Division support a number of large, 
epidemiologic studies on specific populations at increased risk for 
diabetes, especially NIDDM. Additionally, the National Diabetes Data Group 
collaborated with the National Center for Health Statistics in development 
of the Hispanic HANES survey and analysis of the HANES II survey. 



335 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: DIGESTIVE DISEASES AND NUTRITION (DDN) /NATIONAL INSTITUTE OF 

ARTHRITIS, DIABETES, AND DIGESTIVE AND KIDNEY DISEASE (NIADDK) 

TELEPHONE: 301-496-6623 

DESCRIPTION: 

The Division of Digestive Diseases and Nutrition is responsible for the 
extramural support of grant awards and contracts pertaining to diseases and 
disorders of the gastrointestinal tract and associated organs and to 
nutrition. 

• Gallstones 

The prevalence of gallstones in the U.S. is unknown, but the prevalence 
for this disease among Hispanics is suspected to be high. The NIADDK 
and the NCHS have agreed to include an epidemiological study of 
gallstones in two Health and Nutrition Examination Surveys (HANES). 

• Fat-Free Body Composition in Children 

Evidence indicates there is a difference in the fat-free body 
composition of children between sexes and racial groups. NIADDK is 
funding a research investigation on the variation in the fat-free body 
composition of children and youth as a function of maturation, sex, and 
racial background. A combined sample of 475 children using 
cross-sectional and longitudinal studies will include Black, Hispanic, 
and Native American children. 



336 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: KIDNEY, UROLOGIC, AND HEMATOLOGIC DISEASES (DKUHD)/ NATIONAL 
INSTITUTE OF ARTHRITIS, DIABETES, AND DIGESTIVE AND KIDNEY 
DISEASES (NIADDK) 

TELEPHONE: 301-496-6623 

DESCRIPTION: 

Research efforts supported by DKUHD are concentrated on the development of 
new methods of preventive therapy, early diagnosis, and more effective 
treatment through understanding of the basic mechanisms and causes of these 
disorders. 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: PIMA INDIAN STUDIES/NATIONAL INSTITUTE OF ARTHRITIS, DIABETES, AND 
DIGESTIVE AND KIDNEY DISEASES (NIADDK) 

i 

TELEPHONE: 301-496-6623 

DESCRIPTION: 

The Division of Intramural Research covers investigations within the 
Institute's laboratory and clinical facilities in Bethesda and Phoenix. 
Intramural research activities are conducted by eight branches engaged 
primarily in clinical research on arthritis and rheumatic diseases, 
metabolism, endocrinology, hematology, digestive diseases, diabetes, and 
genetics; a ninth branch addresses theoretical mathematical modeling of 
biological problems. 

The Southwestern field studies section continues to investigate the 
determinants of diabetes and its complications during a longitudinal study 
of the natural history of diabetes In the Pima Indian population. 



337 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: CENTER FOR RESEARCH FOR MOTHERS AND CHILDREN/ NATIONAL INSTITUTE OF 
CHILD HEALTH AND HUMAN DEVELOPMENT (NICHD) 

TELEPHONE: 301-496-1971 

DESCRIPTION: 

This program is responsible for the following projects: 

• Premature Births 

Premature birth is defined in terms of low birthweight (2,500 grams or 
less) and/or short gestation, that is, being born too small, too early, 
or both. About 7 percent of all babies in the U.S. are born with low 
birthweight. They account for nearly two-thirds of the 13 per 1,000 
live births infant mortality rate. They also account for a significant 
number of developmental abnormalities seen among survivors. Higher 
premature birth rates among Black, Hispanic, and Native American women 
remain a major health issue. 

Studies supported by the NICHD are examining normal and abnormal factors 
that influence the onset of labor and that Influence the intrauterine 
conditions present in the intrapartum and puerperal periods. Research 
in NICHD Perinatal Emphasis Research Centers addressing this important 
issue includes studies on the endocrine factors, mechanical factors, and 
other indicators of impending labor. 

• Breastfeeding 

There is considerable evidence that breastfeeding is medically, 
nutritionally, and psychologically the best method for feeding human 
infants. Of particular importance from the perspective of infant health 
is the relatively low incidence of breastfeeding among Black, Hispanic, 
and Native American women. 

Intervention strategies to increase breastfeeding will be developed and 
their effects will be tested among multi-ethnic, low- income populations. 

• Transmission of Cardiovascular Risk Factors 

In a cross-cultural genetic and epidemiologic study, 540 pairs of U.S. 
Whites, U.S. Blacks, and Norwegian monozygotic twins are being 
investigated. The unique genetic relationships contained within these 
kinships are to resolve the genetic, environmental and maternal 
determinants of selected anthropometric, biochemical and genetic traits. 

A comparison of the distribution of variation of heart disease risk 
factors in the offspring of the high risk and control families will 
permit a more detailed analysis of existing evidence that maternal 
influence affects several risk factors. An important goal of the 
research will be the testing and modification of existing methodologies 
for the analysis of monozygotic twin kinship data and a cross-cultural 
comparison of the causes for phenotypic variation in three ethnic groups 
located in two quite different geographic areas of the world. 



338 



• Cognitive and Soclo-emotional Development of Young Blacks 
Cognitive and socio-emotional development of young black children in 
the first two years of school is frequently observed to be below that 
of young white children. 

NICHD is examining how social structural variables, such as racial 
and socio-economic mix of the school/classroom and household 
composition (single parents vs. other arrangements), and 
social-psychological factors, such as the performance expectations of 
teachers, peers, and parents, affect children's cognitive and social 
development in the transition to formal schooling. 

• Neonatal Asphyxia 

Low birthweight and premature infants are particularly susceptible to 
neonatal asphyxia which in turn affects cerebral circulation. The 
frequency of such births is elevated in Black infants. 

The NICHD supported minority biomedical research concerned with this 
issue is at Howard University, Washington, D.C. 

• Mild Mental Retardation Intervention 

Black children may be at higher risk of mental retardation consequent 
to depriving psychosocial environments . 

The NICHD supports The Carolina Abecedarian Project, University of 
North Carolina at Chapel Hill, to study the effects of comprehensive 
early day care intervention in the development of Black children at 
risk for mild mental retardation. 

• Psychosocial Maturity in Black Adolescents 

Development of psychosocial maturity in Black adolescents appears to 
follow markedly different patterns than in White adolescents. 

An NICHD grantee is exploring the way in which Black adolescents use 
social networks to solve life problems and achieve more mature 
functioning in such areas as independence, self -concept , work 
orientation, and interpersonal communication. 



339 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: HEALTHY MOTHERS, HEALTHY BABIES PROGRAM/NATIONAL INSTITUTE OF 
CHILD HEALTH AND HUMAN DEVELOPMENT (NICHD) 

TELEPHONE: 301-496-5133 

DESCRIPTION: 

The NICHD has become very active in the Department's Healthy Mothers, 
Healthy Babies program. This past year, the NICHD sponsored one of six 
posters distributed by the HM, HB program to clinics serving low-income, 
pregnant women. Many of these clinic users were minority group members. 
The NICHD sponsored the printing and distribution of 25,000 posters and more 
than 1,000,000 take-home cards emphasizing the importance of prenatal care 
and the importance of keeping clinic appointments. Both the poster and the 
take-home card were printed in English and Spanish. 



340 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: CENTER FOR POPULATION RESEARCH/NATIONAL INSTITUTE OF CHILD HEALTH 
AND HUMAN DEVELOPMENT (NICHD) 

TELEPHONE: 301-496-1971 

DESCRIPTION: 

This Center is responsible for the following programs: 

• Reproductive Disorders 

In co-sponsorship with the Department of Obstetrics and Gynecology of 
the College of Medicine at Howard University, the NICHD participated in 
the organization, conduct, and support of annual or biennial conferences 
on "Highlights and Trends in Reproductive Medicine." These conferences 
are designed to focus on reproductive diseases and disorders, in 
general, and on their occurrence In minority groups, in particular. 

• Contraceptive Risk Profiles Altered Among Hispanics 

The NICHD provided $600,000 to the National Center for Health Statistics 
to augment its Health and Nutrition Examination Survey of American 
Hispanics. This surveillance morbidity survey will be used to 
characterize the risk factors for chronic disease in women who use the 
pill. How the pill alters metabolic measures and health status 
indicators in Hispanics, compared to U.S. White females, will be the 
focus of analysis. To date, over 6,000 Hispanic Americans have been 
interviewed, examined, and given routine screening tests, such as those 
used at admission to the hospital. Complete birth control pill-use 
history questionnaires have also been administered with these surveys. 

• Indochinese Health and Adaptation Research Project 

The NICHD supports several studies on the diversity of health-related 
characteristics of Indochinese refugees and their needs for health 
services as they adapt to the U.S. The most important of these is the 
IHARP (Indochinese Health and Adaptation Research Project) data set 
which contains logitudinal data collected, 1983-84, and reasonably 
representative of the national Indochinese population. 

The IHARP drew heavily upon refugees for staffing through academic 
internships, independent research, and "faculty mentor" programs for 
students who contribute their work in return for research experience and 
academic credit. 

• Black Sexuality 

The program supports a number of researchers who are comparing health 
problems/conditions of minority with White populations. These data 
contain information on sexual activity, fertility, health care during 
pregnancy, including cigarette and alcohol use, pregnancy problems, and 
the health care of infants and children. 



341 



Hispanic Demography Studies 

The program has been very successful in supporting research on Hispanic 
demography. In particular, we have learned that Hispanic groups differ 
among themselves, as well as in comparison to White and Black 
populations. In addition, two companion surveys of the fertility 
patterns of Puerto Ricans in Puerto Rico and New York City were under 
way in FY 1984. There are several studies of the impact and 
assimilation of immigrants which were active in FY 1984. One study 
addresses the specific health problems of Hispanic immigrants in 
California. 



342 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: INTRAMURAL/NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN 
DEVELOPMENT (NICHD) 

TELEPHONE: 301-496-1971 

DESCRIPTION: 

This program is responsible for the following projects : 

• Premature Sexual Development 

The Intramural Research Program made a commitment to undertake clinical 
research among a subset of Puerto Rican children thought to be affected 
by this disorder. Plans were made to bring a number of these children 
to the Clinical Center, NIH, for intensive study and possible therapy. 

• Minority Research Students 

The Intramural Research Program made special efforts during FY 1984 to 
increase the number of minority students exposed to biomedical research 
opportunities. In particular, the FY 1984 summer program was enriched 
in the ratio of minority to non-minority students at both undergraduate 
and graduate levels. Moreover, other NIH programs that focus on 
minority students were used more extensively than had been the case 
previously, including the Federal Junior Fellowship Program and the 
Cooperative Education Program. 

• Low Birthweight 

The NICHD Epidemiology and Biometry Research Program conducted a 
study, using data from a Northern California health plan, 
collected in the mid-1970s, which included White, Asian, Black, 
and Hispanic American women. They examined the extent to which 
major known risk factors, such as smoking, alcohol consumption, 
maternal weight, maternal weight for height, and other demographic 
and reproductive characteristics accounted for differences in 
birth weights. 

- A case control study of factors associated with low birthweight is 
under way in the District of Columbia which includes approximately 
90% of all births to D.C. residents. The project explores the 
risk due to socioeconomic and demographic factors, work history, 
unemployment, stress, exposure, lifestyles and prior and current 
reproductive health. 

To explore the role of infection of the genital urinary tract in 
increasing the risk of preterm and low birthweight delivery among 
Blacks, Whites, and Hispanics, a clinical trial is under 
development. Different organisms, including chlamydia, 
mycoplasma, and streptococci will be examined for their relation 
to low birthweight deliveries. Women will be randomized to 
treatment or placebo after screening at around 24 weeks of 
gestation. 



343 



A study is in progress to identify risk factors associated with 
the birth of intrauterine growth-retarded babies and to determine 
the growth and development of the babies during the first year of 
life. The study compares a Black population in Alabama with a 
White population in Norway and Sweden. 



344 



NATIONAL INSTITUTES OF HEALTH 



PROGRAM: OFFICE OF THE DIRECTOR (OD) NATIONAL INSTITUTE OF DENTAL RESEARCH 
(NIDR) 

TELEPHONE: 301-496-7220 

DESCRIPTION: 

The educational program on dental caries prevention for migrant workers 
and their families is an activity of the Health Promotion and Science 
Transfer Section. "Una buena denadura para usted y su bebe" (Good teeth 
for you and your baby) is a product of the Public Inquiries and Reports 
Section. Over 100,000 copies of this Spanish version of a very popular 
title have been distributed and an equal number remain for distribution 
to individuals and health providers. 



345 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: EXTRAMURAL PROGRAMS /OFFICE OF PREVENTION, EDUCATION AND CONTROL 
(OPEC)/OFFICE OF THE DIRECTOR (OD)/NATIONAL INSTITUTE OF DENTAL 
RESEARCH (NIDR) 

TELEPHONE: 301-496-7220 

DESCRIPTION: 

This program is responsible for the following projects: 

• Growth and Development of the Human Head . The research team will aim 
to elucidate more information on the role of genetics in the 
development of the physiognomy of the face. Equally as important 
will be the effects of the environmental factors on maxillo-facial 
development. Normative data will be developed to give much needed 
facial growth standards on American Blacks to serve as a guide to 
orthodontists, plastic surgeons, maxillo-facial surgeons, 
pedodontists and other physicians, dentists, and health care 
professionals treating American Blacks. 

• A Genetic Study of Cleft Lip and Cleft Palate in Hawaii . The 
proposal intends to study critically the etiological mechanisms of 
human cleft lip with or without cleft palate and isolated cleft 
palate not associated with known syndromes. Clear understanding of 
genetic and nongenetic basis of the etiology of these conditions is 
essential for estimates of recurrence risks for genetic counseling 
and their eventual prevention. 

• Periodontal Diseases and Diabetes in the Gila River Indian 
Community . In the proposed 3-year supplemental project, a team of 
investigators from the State University of New York at Buffalo, 
Periodontal Disease Clinical Research Center will collaborate with 
established diabetics epidemiologists at the NIH, Southwestern Field 
Study Section in Phoenix, Arizona, to study relationships between the 
two diseases in a controlled population of Pima Indians with a high 
prevalence of non-insulin dependent diabetes mellitus . 



346 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: TRAVEL FELLOWSHIPS FOR MINORITY NEUROSCIENTISTS/NATIONAL INSTITUTE 
ON NEUROLOGICAL AND COMMUNICATIVE DISORDERS (NINCDS) 

TELEPHONE: 301-496-9271 

DESCRIPTION: 

The NINCDS in FY 1982 awarded a three-year grant to the Society for 
Neuroscience for the establishment of a program that will provide funds for 
minority students and scientists to attend annual meetings of the Society. 
A major goal of the program is to attract minority students to careers in 
the field of neuroscience. 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: SURVEY OF MAJOR NEUROLOGICAL DISORDERS IN COPIAH COUNTY, 

MISSISSIPPI/NATIONAL INSTITUTE ON NEUROLOGICAL AND COMMUNICATIVE 
DISEASES (NINCDS) 

TELEPHONE: 301-496-9271 

DESCRIPTION: 

The primary objective of the project is to establish the prevalence of major 
neurological and developmental disorders (cerebrovascular disease, 
convulsive disorders, cerebral palsy, psychomotor delay, Parkinson's 
disease, essential tremor, and dementia) in a well-defined population of 
southern Blacks and Whites. 



347 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: CHRONIC CNS DISEASE STUDIES: SLOW, LATENT, AND TEMPERATE VIRUS 
INFECTION/NATIONAL INSTITUTE ON NEUROLOGICAL AND COMMUNICATIVE 
DISEASES (NINCDS) 

TELEPHONE: 301-496-9271 

DESCRIPTION: 

The focus of research efforts is in two large projects. The first involves 
medical surveillance of disease patterns in many primitive and isolated 
populations. Particular attention is directed to child growth and 
development, behavior, and learning. 

In order to determine the usual mode of infection with the virus, a 
worldwide epidemiological study of transmissible visus dementia (CJD) cases 
is under way with special attention to familial clusters of cases with a 
quest for possible relationship of scrapie of sheep to the human disease. 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: SUMMER RESEARCH FELLOWSHIP PROGRAM/ NATIONAL INSTITUTE ON 
NEUROLOGICAL AND COMMUNICATIVE DISEASES (NINCDS) 

TELEPHONE: 301-496-9271 

DESCRIPTION: 

This is a highly selective (competitive) program designed to provide 
research training for medical students contemplating a career in research or 
academic medicine. 

Since the inception of the program in 1982, a total of 22 medical students 
have received short-term research training in the Institute's Intramural 
Research Program. Eighteen (55%) were ethnic minorities, and six (18%) were 
women. 



348 



NATIONAL INSTITUTES OF HEALTH 

PROGRAM: PHARMACOLOGICAL SCIENCES PROGRAM/NATIONAL INSTITUTE OF GENERAL 
MEDICAL SCIENCES (NIGMS) 

TELEPHONE: 301-496-7707 

DESCRIPTION: 

This program supports research and research training concerned with 
providing improved understanding of the biological phenomena and related 
chemical and molecular processes involved in the actions of therapeutic 
drugs and their metabolites. The scope of the research program ranges from 
synthetic chemistry and basic biological and biochemical studies in 
molecular pharmacology, to comparative studies in laboratory animals and 
tissue culture, to controlled clinical studies in normal volunteers and 
patients. 

The NIGMS funds National Research Service Individual Fellowship awards. 
These awards provide basic multidisciplinary research training. The program 
staff seeks to identify minority candidates, and utilizes affirmative action 
principles to select minority candidates for training, provided their 
qualifications and future potential are similar to non-minority candidates. 
The staff also is strongly encouraging program directors of Institutional 
National Research Service awards to make similar efforts. 



349 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: NATIONAL HOSPITAL DISCHARGE SURVEY /NATIONAL CENTER FOR HEALTH 
STATISTICS (NCHS) 

TELEPHONE: 301-436-7050 

DESCRIPTION: 

The National Hospital Discharge Survey was initiated in 1965 to provide 
national statistics on the experience of the civilian population of the U.S. 
in short-stay non-Federal hospitals. Data are abstracted from the face 
sheet of the sampled patient's medical record on demographic characteristics 
of the patient, diagnoses and surgical procedures along with administrative 
information about the hospital stay. 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: NHANES I EPIDEMIOLOGIC FOLLOWUP SURVEY: CONTINUED FOLLOWUP 
1985-86/NATIONAL CENTER FOR HEALTH STATISTICS (NCHS) 



TELEPHONE: 301-436-7050 

DESCRIPTION: 

The first NHANES Survey was conducted from 1971-75. This was the first and 
largest in-depth national survey of health and nutrition ever conducted on a 
representative sample of the U.S. population. In 1982-84 the 14,407 adults 
(ages 25-75 in 1971-75) were traced and information was collected by 
inperson interviews in their homes. The surviving cohort will be 
reinterviewed in 1985-86 by telephone. 



350 



OFFICE OF THE SECRETARY FOR HEALTH 

PROGRAM: NATIONAL MEDICAL CARE UTILIZATION AND EXPENDITURE SURVEY /NATIONAL 
CENTER FOR HEALTH STATISTICS (NCHS) 

TELEPHONE: 301-436-7050 

DESCRIPTION: 

The National Medical Care Utilization and Expenditure Survey (NMCUES), Cycle 
I (1980) was composed of three separate but interrelated surveys designed 
to: (1) provide a statistical base for the Department's health care cost 
containment effort; (2) provide updated, comparable measures of utilization 
and expenditures for monitoring national health insurance programs; and (3) 
provide data on trends and costs over time of health care services for 
different population subgroups (e.g., the poor, the elderly, and the 
uninsured). The survey was cosponsored by the NCHS and HCFA. 

A feasibility study is planned to determine an appropriate methodology to 
collect comparable information for the institutionalized population. This 
study would begin in 1985 and the methodology developed would be used to add 
the insitutionalized population to the next cycle of NMCUES planned for 
1987. The 1987 survey will be called the National Medical Expenditure 
Survey. 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: NATIONAL AMBULATORY MEDICAL CARE SURVEY/NATIONAL CENTER FOR HEALTH 
STATISTICS (NCHS) 

TELEPHONE: 301-436-7050 

DESCRIPTION: 

This survey was begun in 1973 as a continuing survey to gather statistical 
data on ambulatory medical care provided by office-based physicians to the 
population of the U.S. Information about the demographic characteristics of 
patients involved in sampled visits and about the reason for the visit, 
diagnoses, treatments or services and disposition is recorded on a brief 
form by the physician or a staff member. 



351 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: NATIONAL NURSING HOME SURVEY/NATIONAL CENTER FOR HEALTH STATISTICS 
(NCHS) 

TELEPHONE: 301-436-7050 

DESCRIPTION: 

This is a national sample survey of nursing homes, their residents, and 
staff. Resident data are obtained by review of the medical record and by 
interviewing the nurse who usually cares for the resident to determine 
demographic characteristics, health status, participation in social 
activities, monthly charge, and source of payment. Staff members complete a 
self-administered form about their training, previous experience, salary, 
duties performed, and fringe benefits. 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: NATIONAL MASTER FACILITY INVENTORY /NATIONAL CENTER FOR HEALTH 
STATISTICS (NCHS) 

TELEPHONE: 301-436-7050 

DESCRIPTION: 

This is a national inventory of all inpatient health facilities in the U.S. 
which provide medical, nursing, personal, or custodial care to groups of 
unrelated persons. The inventory was initiated in 1962 and is updated 
biennially. 



352 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY/NATIONAL CENTER 
FOR HEALTH STATISTICS (NCHS) 

TELEPHONE: 301-436-7050 

DESCRIPTION: 

This survey measures the prevalence of certain health and nutritional 
conditions, to monitor nutritional indicators and changes in them over time 
and to provide normative data with respect to health characteristics for the 
civilian, noninstitutionalized population of the U.S., ages one month to 74 
years. 

The next survey will be in 1988 (NHANES III) and will oversample for Blacks 
and Hispanics. 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY /NATIONAL CENTER 
FOR HEALTH STATISTICS (NCHS) 

TELEPHONE: 301-436-7050 

DESCRIPTION: 

i 

HHANES was a probability sample survey of persons 6 months through 74 years 
who are of Mexican-American heritage in five Southwestern States, Puerto 
Rican heritage from the New York City area, or Cuban-American heritage from 
the Miami area. The HHANES is similar to the National Health and Nutrition 
Examination Survey with respect to content and operation. 



353 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: VITAL STATISTICS FOLLOWBACK SURVEY PROGRAM/NATIONAL CENTER FOR 
HEALTH STATISTICS (NCHS) 

TELEPHONE: 301-436-7050 

DESCRIPTION: 

Major activities are described below: 

• A 1986 National Mortality Followback Survey will be pretested in 1985 
and fielded in 1986. Data on death rates, hospital and health care 
utilization and disability will be obtained by race and ethnicity. 

• A 1988 National Natality/National Fetal Mortality/National Infant 
Mortality Followback Survey will be planned. The 1988 surveys will 
study low birthweight and infant mortality rates, which are twice as 
high for Black infants as compared with White infants. 

• These surveys are often referred to as "followback" surveys because they 
follow back to one or more informants (e.g., mothers, hospitals, 
physicians, other medical sources) identified on live birth or fetal 
death vital records. Many 1980 data items are comparable to those 
collected in earlier surveys (such as radiation during pregnancy, 
maternal smoking during pregnancy, Caesarean section delivery, future 
birth expectations), thus permitting trend studies in demographic and 
health characteristics of births. The data are used by public health 
specialists, demographers, epidemiologists, health planners, 
policymakers, and other health professionals. 

There are limits on the data that can be collected routinely on all 
death certificates. The purpose of mortality followback surveys is to 
augment the information on mortality characteristics by inquiring more 
fully into various aspects of concern to policymakers, health care 
providers, and administrators. The surveys are conducted primarily by 
mail questionnaire, with followup for nonrespondents by telephone or 
personal interview. 



354 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: NATIONAL VITAL STATISTICS PROGRAM/ NATIONAL CENTER FOR HEALTH 
STATISTICS (NCHS) 

TELEPHONE: 301-436-7050 

DESCRIPTION: 

This program was initiated in 1915 and utilizes the official birth 
certificate filed in each State for each live birth to produce uniform 
national, State, and local data on live births. 

• National Marriage and Divorce Statistics — National statistics on 
marriages and divorces or dissolution of marriages provide data on 
family formation and dissolution and on the sociodemographic 
characteristics of the principals. NCHS makes available only 
statistical summaries of characteristics of marriages and divorces and 
the persons involved. 

• National Mortality Statistics — This program, initiated in 1900, utilizes 
the official death certificate filed in each State for each death to 
produce uniform national, State, and local data on the numbers of 
deaths, the causes of death, and the sociodemographic characteristics of 
decedents. 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: NATIONAL SURVEY OF FAMILY GROWTH/NATIONAL CENTER FOR HEALTH 
STATISTICS (NCHS) 

TELEPHONE: 301-436-7050 

DESCRIPTION: 

This program is a nationally representative survey of women in the 
childbearing ages, which has been conducted periodically by the NCHS since 
1971. The NSFG is an important — in some cases, the only — source of 
nationwide data for monitoring trends and evaluating programs in such public 
health areas as: unwanted childbearing and the effectiveness of family 
planning services — adolescent pregnancy, sexually transmitted diseases, sex 
education, prenatal care, Caesarean-section deliveries, and unmarried 
cohabitation. 

Survey data permit analysis for ever-married, as well as never married, 
women by age group within the Black population that can be compared with 
comparable statistics for White women. Data for Black women are shown in 
published reports and are available on public use data tapes from the survey. 



355 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: NATIONAL HEALTH INTERVIEW SURVEY/NATIONAL CENTER FOR HEALTH 
STATISTICS (NCHS) 

TELEPHONE: 301-496-7050 

DESCRIPTION: 

This survey is a cross-sectional household survey of the civilian non- 
institutionalized population of the U.S. Its purpose is to provide national 
data on the incidence of acute illness and accidental injuries, the prev- 
alence of chronic conditions and impairments, the extent of disability, 
the utilization of health care services, and other health related topics, 
in addition to information on basic demographic and socioeconomic character- 
istics of household members. 



356 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: HEALTHY MOTHERS, HEALTHY BABIES COALITION/OFFICE OF PUBLIC AFFAIRS 

TELEPHONE: 202-245-3102 

DESCRIPTION: 

The Healthy Mothers-Healthy Babies Coalition subcommittee on low income 
women is undertaking a national survey of successful strategies and 
techniques for motivating low income pregnant women to seek prenatal 
care. The study will be published as a compendium of program ideas for 
working with low income women and a summary of behavioral research in 
this area. 



357 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 



PROGRAM: INFORMATION AND EDUCATION ON ACQUIRED IMMUNE DEFICIENCY SYNDROME/ 
OFFICE OF PUBLIC AFFAIRS 

TELEPHONE: 202-245-6867 

DESCRIPTION: 

In addition to knowledge of the syndrome, related tests and symptoms, 
this group needs to understand what the "at risk" designation means, 
precautions for avoiding contracting the syndrome, and sufficient under- 
standing of the means of AIDS transmission so that they can counter mis- 
conceptions about the syndrome which are directed against them. 

The Office of Public Affairs has reordered "Lo que todos deben saber 
sobre AIDS," a 16-page cartoon booklet in Spanish, for the general public. 



358 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: NATIONAL HEALTH PROMOTION PROGRAM/ OFF ICE OF DISEASE PREVENTION AND 
HEALTH PROMOTION (ODPHP) 

TELEPHONE: 202-472-5660 

DESCRIPTION: 

The purpose of the National Health Promotion Program is to educate the 
public about environmental, occupational, societal, and behavioral factors 
which affect health in order that individuals may make informed decisions 
about health-related behavior. It also serves as a Federal focal point for 
the development, implementation, and coordination of programs that promote 
good health habits designed to prevent disease and disability. 



359 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: NATIONAL HEALTH INFORMATION CLEARINGHOUSE (NHIC) /OFFICE OF DISEASE 
PREVENTION AND HEALTH PROMOTION (ODPHP) 

TELEPHONE: 202-522-2590 

DESCRIPTION: 

The National Health Information Clearinghouse (NHIC) has four specific 
objectives: 

• To identify health information resources; 

• To channel requests for information to these resources; 

• To provide one-stop service to the Inquirer; and 

• To develop publications providing information on health-related topics 
of widespread interest. 

The NHIC accomplishes these objectives through the following activities: 

• Database Development 

• Information Services 

• National Information Center for Orphan Drugs and Rare Diseases (NICODARD) 

• Materials Collection 

• Publications, and 

• Materials Dissemination 



360 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: 1990 OBJECTIVES FOR THE NATION INITIATIVE/OFFICE OF DISEASE 

PREVENTION AND HEALTH PROMOTION (ODPHD) /PUBLIC HEALTH SERVICE (PHS) 

TELEPHONE: 202-245-7611 

DESCRIPTION: 

A series of measurable objectives to be achieved by 1990 has been 
established and published in Promoting Health/ Preventing Disease: 
Objectives for the Nation . These objectives are national guideposts for 
Federal and non-Federal prevention efforts, and the ODPHP oversees 
implementation efforts involving all PHS agencies, as well as state and 
local governments and private and voluntary organizations. A number of 
objectives pertain specifically to minority populations in the areas of 
disease prevention, health protection, and health promotion. 



361 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: U.S. TASK FORCE ON PREVENTIVE SERVICES/OFFICE OF DISEASE 

PREVENTION AND HEALTH PROMOTION (ODPHP) /PUBLIC HEALTH SERVICE (PHS) 

TELEPHONE: 202-245-7611 

DESCRIPTION: 

In 1984 the Department of Health and Human Services convened the U.S. 
Preventive Services Task Force composed of prominent researchers, clinicians 
and scholars to review the scientific basis of over 100 clinical preventive 
interventions and to develop a set of recommendations for the use of 
preventive services in clinical settings. Recommendations will be made as 
to appropriate packages of preventive interventions for particular age and 
sex specific groups, risks and conditions. Depending upon the strength of 
the scientific evidence, recommendations for inclusion of a given preventive 
service will be further defined by three criteria: effectiveness, burden of 
suffering, and detection. Smoking, immunization, inappropriate use of 
alcohol, breast cancer screening, dietary fat, motor vehicle injury, and 
functional dependence in the elderly are among the topics which the Task 
Force has considered. The Task Force's final report will contain all of its 
recommendations accompanied by an implementation guide discussing the 
behavioral and structural issues that influence the integration of 
preventive services into clinical settings. 



362 






OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: REFUGEE PREVENTIVE HEALTH (RPH) /OFFICE OF REFUGEE HEALTH 
(ORH)/ PUBLIC HEALTH SERVICE (PHS) 

TELEPHONE: 301-443-4130 

DESCRIPTION: 

This program provides funds for (1) monitoring overseas medical screening 
and health services provided to U.S. bound refugees, (2) inspecting refugees 
at U.S. ports of entry and notifying local health departments of the arrival 
of refugees, and (3) technical assistance to other Federal, non-Federal 
governmental and private agencies regarding refugee health matters both 
overseas and in the U.S. 

Current program activities include: 

• Monitoring the medical screening of refugees overseas ; 

• Referring refugees to U.S. health departments, after arrival in the 
U.S., for followup of conditions such as tuberculosis and serious mental 
health problems and for health assessments; 

• Improving health services for U.S. bound refugees in overseas camps and 
refugee processing centers (particularly in Southeast Asia); and, 

• Development in conjunction with the Office of Refugee Resettlement, a 
national strategy for improving culturally sensitive mental health 
services to overseas refugees awaiting resettlement in the U.S. and to 
refugees already resettled here. 



363 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: CUBAN/HAITIAN ENTRANT PROGRAM/OFFICE OF REFUGEE HEALTH 
(ORH)/PUBLIC HEALTH SERVICE (PHS) 

TELEPHONE: 301-443-4130 

DESCRIPTION: 

PHS provides, or arranges for, all health screening, physical and mental 
health services for Cuban and Haitian entrants who are detained by INS (in 
other than Bureau of Prisons facilities) or who require special mental 
health services prior to their resettlement or parole into the U.S. 

Special mental health programs are being provided to Cuban entrants both in 
Federal facilities or in Federally- funded, community-based treatment 
facilities. 

Other detained aliens are receiving comprehensive services from PHS staff in 
INS facilities or in community hospitals (at PHS expense) depending on the 
level of required care. 



364 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 

PROGRAM: HEALTH PROGRAM FOR REFUGEES/OFFICE OF REFUGEE HEALTH (ORH)/ PUBLIC 
HEALTH SERVICE (PHS) 

TELEPHONE: 301-443-4130 

DESCRIPTION: 

This program assists States and localities in providing health assessments 
to newly arrived refugees and in addressing refugee health problems of 
public health concern. 



365 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 



PROGRAM: ADOLESCENT FAMILY LIFE/OFFICE OF ADOLESCENT PREGNANCY PROGRAMS 
(OAPP)/ OFFICE OF POPULATION AFFAIRS (OPA) 

TELEPHONE: 301-245-6335 

DESCRIPTION: 

The objective of the Adolescent Family Life program is the development of 
effective alternative approaches to the multifaceted problems of adolescent 
pregnancy. The program supports demonstration projects that provide com- 
munities around the country with model programs for effective care services 
for pregnant adolescents and adolescent parents and prevention services to 
encourage postponement of adolescent premarital sexual activity. 



366 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 



PROGRAM: FAMILY PLANNING PROGRAM, TITLE X OF THE PUBLIC HEALTH SERVICE ACT/ 
OFFICE OF ADOLESCENT PREGNANCY PROGRAMS (OAPP)/OFFICE OF POPULATION 
AFFAIRS 

TELEPHONE: 301-245-6335 

DESCRIPTION: 

This activity supports project grants for voluntary family planning 
projects that offer a broad range of acceptable and effective family 
planning methods and services including natural family planning methods 
and infertility services. Other program activities include grants and 
contracts for training of family planning services personnel, services 
delivery improvement research and family planning information and 
education. 



367 



OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 



PROGRAM: INVENTORY OF DHHS ACTIVITIES CONCERNED WITH INFANT MORTALITY AND 
LOW BIRTHWEIGHT/OFFICE OF HEALTH PLANNING AND EVALUATION 

TELEPHONE: 202-472-7906 

DESCRIPTION: 

In September, 1984 an Inventory of Department of Health and Human Services 
Activities Concerned with Infant Mortality and Low Birthweight was prepared 
under contract at the request of the Assistant Secretary for Health. A 
total of 119 programs are listed covering such areas as research, services, 
demonstration and evaluation projects. 



368 



OFFICE OF THE ASSISTANT SECRETARY FOR HUMAN DEVELOPMENT SERVICES (OHDS) 

PROGRAM: ADMINISTRATION FOR NATIVE AMERICANS (ANA) 

TELEPHONE: 202-245-6546 

DESCRIPTION: 

The Administration for Native Americans (ANA) provides a Departmental focus 
for the special concerns of American Indians, Alaskan Natives, and Native 
Hawaiians. 

ANA's Social and Economic Development Strategy (SEDS) concentrates on the 
executive functions and institutions of tribal governments and on 
reinforcing or developing systems required for achieving improved social 
development, economic progress, and service delivery. 



369 



OFFICE OF THE ASSISTANT SECRETARY FOR HUMAN DEVELOPMENT SERVICES (OHDS) 

PROGRAM: ADMINISTRATION ON DEVELOPMENTAL DISABILITIES (ADD) 

TELEPHONE: 202-245-2897 

DESCRIPTION: 

The Administration on Developmental Disabilities (ADD) is the primary 
agency in the Office of Human Development Services for planning and 
implementing programs on behalf of disabled people. ADD works through 
State agencies to improve services to persons with developmental 
disabilities. The agency also is charged by law with leveraging, 
accessing, and coordinating service programs funded under other 
appropriations . 

A major component of the program is the basis State grant-a-formula grant 
to States for planning, administration, and services. 



370 



OFFICE OF THE ASSISTANT SECRETARY FOR HUMAN DEVELOPMENT SERVICES 
PROGRAM: ADMINISTRATION FOR CHILDREN, YOUTH, AND FAMILIES (HEAD START) 
TELEPHONE: 202-755-7794 
DESCRIPTION: 
Head Start activities in the area of health includes: 

Preventive health screenings, examinations, and treatment services. 

Nutrition Services. 

Health education and information dissemination. 

Health /nutrition supplies and equipment. 

Staff (health coordinators, etc.). 

Approximately 6% of Head Start's FY 84 funds were budgeted for health 
services (medical, dental, and mental health). An additional 6% of Head 
Start's FY 84 funds were budgeted for nutrition services. These data do not 
include the 59,441 handicapped children who are enrolled in Head Start. 



371 



OFFICE OF THE ASSISTANT SECRETARY FOR HUMAN DEVELOPMENT SERVICES 



PROGRAM: COORDINATED DISCRETIONARY FUNDS PROGRAM/ OFFICE OF POLICY 

DEVELOPMENT (OPD) /DIVISION OF RESEARCH AND DEMONSTRATION (DRD) 

TELEPHONE: 202-245-6233 

DESCRIPTION: 

The HDS Coordinated Discretionary Fund Program is based on the principle 
that the well-being of the public is the responsibility of individuals, 
families, and the communities in which they live. 

HDS is primarily interested in providing short-term funds for projects 
of immediate impact or which can become self-sustaining in a short 
period of time. The HDS Coordinated Discretionary Funds Program is 
not intended to provide funds for ongoing social services or to serve as 
a supplemental source of funds for local activities which need operating 
subsidies. 



372 



OFFICE OF THE ASSISTANT SECRETARY FOR HUMAN DEVELOPMENT SERVICES 

PROGRAM: GERONTOLOGY TRAINING /ADMINISTRATION ON AGING (AOA) 

TELEPHONE: 202-472-4224 

DESCRIPTION: 

Project grants are awarded to colleges and universities for development 
of gerontology programs offering specialized training to individuals 
prepared for careers in the field of aging. 

Under its Historically Black Colleges and Universities (HBCU) Initiative, 
AOA has funded projects at Spelmen College and Cheyney State University 
to provide training for older Blacks in health promotion. AOA also has 
funded efforts by Meharry Medical College to ensure gerontological/ 
geriatric training for health professional students. 



373 



OFFICE OF THE ASSISTANT SECRETARY FOR HUMAN DEVELOPMENT SERVICES 

PROGRAM: TITLE III OF THE OLDER AMERICAN'S ACT PART B - NUTRITION 
SERVICES /ADMINISTRATION ON AGING (AOA) 

TELEPHONE: 202-245-0727 

DESCRIPTION: 

The objective of this program is to provide older Americans with low cost 
nutritious meals and with appropriate nutrition education and other 
appropriate nutrition services. Meals may be served in a congregate setting 
or delivered to the home. The nutrition portion of this program Is funded 
on a Federal/State matching basis at a ratio of 85-15. 

Additionally, the AOA has underway an initiative to increase minority 
participation in Older Americans Act programs. States have developed action 
plans which are in progress during 1985. 



374 



OFFICE OF THE ASSISTANT SECRETARY FOR HUMAN DEVELOPMENT SERVICES 

PROGRAM: TITLE IV, OLDER AMERICAN'S ACT, GRANTS TO INDIAN TRIBES FOR 

SUPPORTIVE AND NUTRITION SERVICES/ ADMINISTRATION ON AGING (AOA) 

TELEPHONE: 202-245-1826 or 202-245-0011 

DESCRIPTION: 

Funds are available through grants to eligible Indian tribal organizations 
to promote the delivery of services comparable to services provided under 
Title III programs for Indians not served by Title III programs. These 
services include services necessary for the welfare of older Indians such 
as: water services, road clearing, nutrition services, and any other 
services authorized under Title III. Funds may also be used for the 
alteration, lease, or renovation of a facility to be used as a multipurpose 
Indian senior center and for staffing the center. 



375 



OFFICE OF THE SECRETARY 

PROGRAM: ASSISTANT SECRETARY FOR PLANNING AND EVALUATION (ASPE) 

TELEPHONE: 202-245-6102 

DESCRIPTION: 

Assessment of Indian Health Service Systems Capabilities . The purpose of 
this project is to develop general specifications suitable for use in a cost 
accounting system to support the use of DRGs in management of IHS 
hospitals. The end product will be an RFP for use in the procurement of 
such a system. 

Analysis of DHHS Financial Support to and the Socio-Economic Condition of 
Indian Tribes . The purpose of the project is to exploit a data base on 
Indian Tribes developed by ASPE/PS. The analysis will provide information 
on American Indian tribes across a variety of socio-economic, demographic, 
and financial assistance variables. 



376 



OFFICE OF THE SECRETARY 

PROGRAM: OFFICE FOR CIVIL RIGHTS/OFFICE OF THE DIRECTOR 

TELEPHONE: 301-426-4232 

DESCRIPTION: 

OCR activities focus on selected investigations and reviews. A number 
of compliance reviews of State agencies resulted in agreements that will 
enhance service accessibility for minorities and the handicapped on a 
statewide basis. Other activities are provided below: 

Project Reviews . Project reviews focus on identified issues, often under a 
single jurisdiction. The reviews are intended to generate change in prac- 
tices, policies, and procedures on an expedited basis. 

Outreach and Technical Assistance . During FY 1984 OCR greatly expanded 
its non-case related outreach and technical assistance initiatives as 
part of its effort to increase the number of recipients complying volun- 
tarily with civil rights requirements. 

Older Americans Project . During FY 1984 OCR initiated a special project 
aimed at helping States to reduce discrimination against senior citizens 
and to improve services provided to these citizens. Specific changes that 
have taken place in some of the project's states include: 

Increasing the range of meal choices for cultural groups with 
different food preferences. 

- Moving of nutrition sites to locations that are more accessible 
to the minority elderly. 

Refugee Resettlement Project . This outreach and voluntary compliance 
project addresses discrimination in the delivery of health care services 
to Southeast Asian refugees. As part of the project OCR has: 

- Established networks and relationships with State Refugee Co- 
ordinators, Regional Offices of Refugee Resettlement, Mutual 
Assistance Agencies, voluntary agencies, and beneficiary 
communities. 

- Established language banks to provide qualified interpreters on 
a 24-hour basis to health care providers. 

- Assisted beneficiary groups in developing a service needs 
assessment. 

- Provided technical assistance to health care providers to help 
them to serve the refugee community more effectively. 

- Disseminated Indo-Chinese translations of basic OCR information 
documents to various refugee groups and State Refugee Agencies. 



377 



SOCIAL SECURITY ADMINISTRATION 

PROGRAM: HEALTH- RELATED PROGRAM/DISABILITY INSURANCE/OFFICE OF DISABILITY 
MEDICAL EVALUATION (ODME) 

TELEPHONE: 301-594-1761 

DESCRIPTION: 

SSA conducts two disability programs — Title II Disability Insurance (DI) 
and Title XVI Supplemental Security Income (SSI). Both programs are 
income replacement programs and not directly related to the provision 
of health services. The former is based on an earned right derived from 
employee-employer payments into a Disability Trust Fund. The latter is 
based on need and is a welfare-type program paid from Federal (and State) 
general tax funds. 



378 



Survey of the Non-Federal 
Community 




SURVEY OF NON-FEDERAL ORGANIZATIONS 

Introduction 

The Task Force conducted a nationwide survey of approximately 300 
individuals and organizations that represent health-specific 
professional, scientific, and service groups. The survey was intended 
to elicit information on ways the Department might improve the health 
status of minority Americans . 

The survey asked four questions: 

(1) From the perspective of your organization and the people you 
represent, what are the three most critical health disparities 
between minority and nonminority Americans? 

(2) For the disparities you identified, what appear to be the most 
significant contributing factors? 

(3) Highlighting specific examples known to your organization, 
what kinds of health programs in the minority community have 
been most successful? What has been the key element of that 
success? 

(4) Within the confines of the current Department of Health and 
Human Services' (DHHS) programs and policies, how might DHHS 
better address the disparity in the health status of minority 
populations? 

The following represents a summary of the 125 survey responses 
received by April, 1985. 

Summary of Responses 

The plight of many minority people in need of health care is 
captured in this excerpted comment: 

"Preventive care is often a luxury that time rarely affords 
minority people. One is inclined to ignore a cough, a lump in the 
breast, or even an advancing pregnancy when the demands of daily 
existence are overtaxing. These ceaseless demands for employment, 
housing, food, clothing, legal help, public assistance, etc., are 
sufficient to ensure that many illnesses or conditions reach a 
critical point before health care is sought. 

Socioeconomic issues influencing health status were frequently 
cited as contributors to the disparity. These included: the 
prevalence of poverty among minority groups, low income, unemployment, 
lack of health insurance, and inability to pay deductibles or 






381 



copayment costs of insurance. Another aspect mentioned frequently by 
respondents was the reduction in Government funding for health care 
services and programs for minorities. 

Many respondents believe that the major health disparities could be 
reduced through improved access to health care services and programs. 
These need to be designed and operated to be culturally sensitive to 
the specific minority population being served. The types of services 
most often advocated by respondents were health education and 
disease prevention programs. 

Suggestions for improving health care services and programs for 
minorities were: 

• Continued support for existing successful health programs. 

• Minority-specific research and data collection. 

• Prevention and health education programs that incorporate 
bicultural/bilingual services. 

• Minority participation in policy development. 

• Education and training programs. 

• Improved access to health care through modification of third- 

party payer systems. 

Specific Issues 

From the perspective of your organization and the people you 
represent, what are the three most critical health 
disparities between minority and nonminority Americans? 

For the disparities you identified, what appear to be the 
most significant contributing factors? 

The responses to the first two questions are reported together 
because of the linked nature of the majority of responses received. 
The most critical disparities identified by the respondents were in 
the areas of: 

• Access to health care. 

• Chronic diseases. 

• Pregnancy and birth disorders . 

• Availability of data. 



382 



Access to Health Care 

Problems concerning minority access to health care cut across all 
responses. Some respondents cited access to health services as a 
primary disparity, while others identified access as a secondary issue 
or a contributing factor to the primary disparities. For example, 
chronic disease conditions were often mentioned as a disparity; 
however, access to proper health care was listed as a strong 
contributor to the prevalence of this disparity. 



were: 



Two major areas of concern in health care access for minorities 

• The lack of certain types and numbers of services and programs. 

• Barriers to existing services. 

In addition, the need for generally improved access, quality, and 
utilization of services such as primary care, screening, detection, 
treatment, follow-up, and public (health) education programs were 
frequently cited. Current health services' research and promotion were 
pinpointed as inappropriate or inadequate for identifying, 
communicating with, convening, and involving minorities through 
community-based groups, such as: schools, churches, Health 
Maintenance Organizations (HMOs), worksites, and voluntary health 
groups. In addition, the paucity of screening and health education 
programs was identified as a leading cause of delayed diagnosis and 
the poor prognosis for medical problems. 

Specific problems of access to health care included: 

• Lack of health care for mothers and children. 

• Lack of access to services for early detection of diseases such 
as cancer, hypertension, and diabetes and other specialty health 
care. 

• Inability of non-English speaking people to use freely the health 
care system because of language and cultural barriers. 

• Less access to, and inappropriate use of, health services. 

• Poor quality of health care. 

• Underutilization of existing health resources because of a lack 
of knowledge and motivation. 

• Lack of physicians in rural areas. 



383 



• Problems with health care facilities, including af fordability, 
location, hours of operation, and transportation to and from 
the facilities. 

The major theme of these responses pointed to a need for more 
health education programs tailored to the minority group being served, 
on the following issues: prenatal and infant care, proper nutrition 
and weight reduction, management of chronic illnesses, family planning 
and sex education, and alcohol and drug abuse counseling. Respondents 
often stressed the need for programs that emphasize preventing disease 
and promoting good health and good health practices. 

Chronic Diseases 

Hypertension (high blood pressure), cardiovascular disease, 
cerebrovascular disease, cancer, and diabetes were most often cited as 
specific diseases that contribute to the health disparity. Most 
respondents believed that, if adequate screening programs were available and 
utilized, more chronic diseases experienced by minorities could 
be detected early. Respondents also believed that effective patient 
education and follow-up programs would help to reduce illness and death. 

Pregnancy and Birth Disorders 

Pregnancy-related concerns such as infant mortality, low 
birthweight infants, and prenatal, perinatal, and postnatal care were 
cited by many respondents as major issues. 

Access to proper health care was again cited. In the view of 
most respondents, early and adequate prenatal care and counseling is 
unavailable or underutilized among minority populations. Also, access 
to high technology techniques was seen as inadequate, creating a 
higher incidence of complications of pregnancy and birth. 

Many factors that contribute to pregnancy and birth disorders were 
believed to be manageable with proper access to appropriate, adequate, 
and early care. Such care includes regular prenatal checkups, 
nutrition counseling, management of any chronic health problems, and 
postnatal care for infants and mothers. Access to family planning 
services was often mentioned as potentially helpful in reducing low 
birthweight and infant mortality. 

Availability of Data 

Inadequacy of data on minorities was cited as a major barrier to 
developing effective health care strategies and programs. The lack of 
data for Hispanics and Asian/Pacific Islanders was cited most often. 



384 



Other Disparities 

Respondents noted a number of other areas of disparity: 

• Homicide, suicide, and unintentional injuries; alcohol and drug 
abuse; and problems related to stress. 

• Inadequate education. 

• Poor nutrition. 

• Underrepresentation of minorities in the health professions. 

• Problems related to environment, such as housing and unsanitary 
living conditions. 

• Discrimination, deterioration of the family structure, lack of 
support services and recreational facilities, and low self-esteem. 

The quality of education that many minorities receive and their 
lower educational attainment have a substantial impact on their 
socioeconomic status, in the opinion of respondents. Educational 
deficits were believed to be caused by such factors as insufficient 
parental guidance, lack of encouragement to achieve, and lack of 
emphasis on education in general. Low educational attainment is seen 
as both a result and a cause of low socioeconomic status . 

Poor nutrition was cited by respondents as affecting nearly every 
aspect of health, particularly in diseases such as diabetes and 
hypertension and in relation to pregnancy and birth. 

Too few minorities in health care professions was mentioned as 
contributing to the cultural insensitivity that is said to exist in 
many health care facilities. Factors cited for underrepresentation 
include a lack of educational opportunity and financial and political 
resources for training of minorities in health care professions. 

Environmental concerns expressed by respondents included inadequate 
housing, unsanitary and unsafe working and living conditions, exposure to 
hazardous chemicals and materials in the worksite and in homes, and the 
danger of lead poisoning in children. 

Elements of Successful Programs 

Highlighting specific examples known to your organization, 
what kinds of health programs in the minority community have 
been most successful? What has been the key element of that 
success? 

Certain common elements seemed to contribute to the success of many 
health programs described by the respondents. These key elements include: 



385 



• Community involvement and outreach. 

• Program focus on comprehensive services, including disease 
prevention and health promotion. 

• Program ability to improve minority access to health services. 

• Cultural sensitivity to the group being served. 

Examples of health programs that have been successful in minority 
communities included: community outreach; hypertension control; 
maternal and child health care; family planning; health education, 
promotion, and prevention; bicultural and bilingual health care; and 
Medicare and Medicaid. In general, improved access to medical care 
was cited as a key element of a program's success; however, success 
was by no means limited to this element alone. 

All groups representing Blacks, Hispanics , Native Americans, and 
Asian/Pacific Islanders addressed community -based health programs. 
They cited comprehensive health services, such as dental care, social 
services, public health education, outreach, and prevention programs, 
as essential components to community health programs. The key element 
of success for these programs was that they were accessible and 
affordable. Other elements of success for community health programs 
included cultural sensitivity, networking with other agencies in the 
community, and control of health programs by community boards. 

Hypertension Detection and Follow-up Programs and maternal and 
child health care programs were regarded as successfully demonstrating 
these qualities. 

All groups emphasized health education, promotion, and prevention 
programs as successes in minority communities, based on experience 
with planning and delivery of services. 

All groups cited Medicare and Medicaid as successful programs. 
Respondents attributed success to improved accessibility and 
availability of quality health care to the socioeconomically deprived. 
Financial assistance and Government funding were also perceived as 
increasing opportunities for minority employment in the health care 
field; otherwise, such employment may not have been possible. 

Suggestions for Action 

Within the confines of the current Department of Health and 
Human Services programs and policies, how might DHHS better 
address the disparity in health status of minority 
populations? 



386 



Respondents proposed a variety of specific ways that DHHS might 
better address disparities in health status of minority populations, 
including the following: 

• Continue to support or fund existing health programs that have 
been successful. 

• Improve data collection and interpretation of data regarding 
specific minority groups. 

• Direct resources to prevention activities for high-risk minority 
populations . 

• Increase funding for health education programs and research on 
health disparities. 

• Incorporate bicultural/bilingual services into health programs. 

• Network with private medical and social communities. 

• Develop public education programs and other programs encompassed 
by the 1990 Objectives for the Nation . 

• Increase minority participation in policy development, education, 
and training programs, thereby increasing equal opportunity for 
minorities . 

• Increase accessibility to quality health care. 

• Encourage third-party payers to include coverage for health 
promotion/disease prevention. 

All groups recommended that DHHS target programs to populations 
and geographic areas with the highest rates of mortality and 
morbidity. They placed particular emphasis on the need to provide 
adequate funding for health education, prevention, and research for 
poor and minority populations and to support minority health programs 
within the community. 

In addition, minority groups indicated that DHHS might address 
the health disparities of minority populations more effectively by 
making appropriate use of viable and successful community programs and 
institutions, including families, churches, schools, small businesses, 
and others . 

All minorities who responded to the survey endorsed minority 
participation in policy development. 



387 



RESPONDENTS TO THE SURVEY OF THE NON-FEDERAL COMMUNITY— ORGANIZATIONS 



Faith Mayhew 
Executive Secretary 
Affiliated Tribes of 

Northwest Indians (ATNI) 
517 Southeast 28th Avenue 
Portland, Oregon 97214 

Bella Zi Bell 

ALU LIKE, Inc. 

Third Floor 

401 Kamakee Street 

Honolulu, Hawaii 96814 

Paul Gerald Marx 

Secretary 

Committee on Minority Officers 

American Academy of Family 

Physicians 
1740 West 92nd Street 
Kansas City, Missouri 64114 

C. Anne Harvey 

Associate Director 

Program and Field Services Division 

American Association of Retired Persons 

1909 K Street, N.W. 

Washington, D.C. 20049 

Arthur I. Holleb, M.D. 
Senior Vice President for 

Medical Affairs 
American Cancer Society 
777 Third Avenue 
New York, New York 10017 

Elaine Locke 

Program Associate 

Practice Activities 

American College of Obstetricians 

and Gynecologists 
Suite 300 E 

600 Maryland Avenue, S.W. 
Washington, D.C. 20024 

Karl E. Sussman, M.D. 

President 

American Diabetes Association 

2 Park Avenue 

New York, New York 10016 



Linda Hiddeman Barongess 

Executive Vice President 

American Geriatrics Society 

Room 1470 

10 Columbus Circle 

New York, New York 10019 

William Wells 

President 

American Heart Association 

Nation's Capitol Affiliate 

2233 Wisconsin Avenue, N.W. 

Washington, D.C. 20007 

Podge M. Reed, Jr. 

Director 

American Hospital Association 

444 North Capitol Street, N.W. 

Washington, D.C. 20001 

William LaRoque 
Technical Specialist 
American Indian Health 

Care Association 
245 East Sixth Street 
St. Paul, Minnesota 55101 

Nancy Tuthill 

Director 

American Indian Law Center, Inc. 

P.O. Box 4456, Station A 

1117 Stanford, N.E. 

Albuquerque, New Mexico 87196 

Eunice Cole, R.N. 

President 

American Nurses Association 

2420 Pershing Road 

Kansas City, Missouri 64108 

Juanita Hunter, Ed.D. , R.N. 
Cabinet on Human Rights 
American Nurses Association 
2420 Pershing Road 
Kansas City, Missouri 64108 

Chester Pierce, M.D. 

President 

American Orthopsychiatric 

Association 
Suite 1616 
19 West 44th Street 
New York, New York 10036 



388 



Lillian Comas-Diaz, Ph.D. 
Administrative Officer 
American Psychological Association 
1200 17th Street, N.W. 
Washington, D.C. 20036 

Seiko Brodbeck 

Associate Executive Director 
American Public Health Association 
1015 15th Street, N.W. 
Washington, D.C. 20005 

William Chen 
Asian Caucus 
American Public Health 

Association 
Health Education Department 
University of Florida 
Room 4, FLG 
Gainesville, Florida 32611 



David Ozonoff 
American Public Health 

Association/PDB 
Boston University School 

of Public Health 
80 East Concord Street 
Boston, Massachusetts 02115 

Victor W. Sidel, M.D. 

President 

American Public Health Association 

1015 15th Street, N.W. 

Washington, D.C. 20005 

Richard F. Schubert 
President 

American Red Cross 
National Headquarters 
430 17th Street, N.W. 
Washington, D.C. 20006 



Roger L. DeRoos 
Environment Section 
American Public Health 

Association 
University of Washington 
GS-05 
Seattle, Washington 98105 

Gail Gordon, Dr.P.H. 

American Public Health Association 

Department of Health Sciences 

Jersey City State College 

2039 Kennedy Boulevard 

Jersey City, New Jersey 07305 

Andrew B. James, Dr. P.H. 

President 

Black Caucus of Health Workers 

American Public Health 

Association 
Vice Chairman 
Black Congress on Health, 

Law, and Economics 
Houston, Texas 77225 

Steven Uranga McKane, D.M.D., M.P.H. 

President 

Latino Caucus 

American Public Health Association 

Hartford Health Department 

80 Coventry Street 

Hartford, Connecticut 06112 



William V. D'Antonio 

Executive Officer 

American Sociological Association 

1722 N Street, N.W. 

Washington, D.C. 20036 

La Donna Harris 

President 

Americans for Indian Opportunity 

Suite 200 

1010 Massachusetts Avenue, N.W. 

Washington, D.C. 20001 

E. Thomas Colosimo 

Executive Director 

ARROW 

Suite 401 

1000 Connecticut Avenue, N.W. 

Washington, D.C. 20036 

Herbert Z. Wong, Ph.D. 

President 

Asian-American Psychological 

Association 
3626 Balboa Street 
San Francisco, California 94121 

Barbara Morita 
Asian Health Services 
310 Eighth Street 
Oakland, California 94607 



389 



John A. D. Cooper, M.D. 
Association of American 

Medical Colleges 
Suite 200 

1 Dupont Circle, N.W. 
Washington, D.C. 20036 

George K. Degnon 
Executive Director 
Association of State and 

Territorial Health Officials 
131 1-A Dolley Madison Boulevard 
McLean, Virginia 22101 

Arthur H. Coleman, M.D. 

Executive Director 

Black Congress on Health, 

Law, and Economics 
6301 Third Street 
San Francisco, California 94124 

Amelie G. Ramirez 

Director 

Health Promotion 

Baylor College of Medicine 

1919 Mustang Springs 

Missouri City, Texas 77459 

Kenneth Edelin, M.D. 

Chairman and Professor 

Obstetrics and Gynecology 

Boston University School of Medicine 

720 Harrison Avenue 

Boston, Massachusetts 02118 

Nancy Evans 

Navajo Area Office 

Bureau of Indian Affairs 

P.O. Box 1060 

Window Rock, Arizona 86515 

Mohammed-Fo r ouz es h 
Department of Health Service 
California State University 

of Long Beach 
1250 Bellview Boulevard 
Long Beach, California 92840 

Ward Cates, M.D., M.P.H. 

Director 

Division of Sexually Transmitted 

Diseases 
Centers for Disease Control 
Atlanta, Georgia 30334 



Sara Rosenbaum 

Director 

Child Health 

Children's Defense Fund 

Suite 400 

122 C Street, N.W. 

Washington, D.C. 20007 

John H. C. Chiu, M.D. 

Chinese Canadian Medical Society 

(Ontario) 
50 Michael Drive 
North York, Ontario M2H 2A5 
CANADA 

Veronica Ng 

Chinese for Affirmative Action 

121 Waverly Place 

San Francisco, California 94108 

Harry Lee, M.D. 

Chief of Staff 

Chinese Hospital 

845 Jackson Street 

San Francisco, California 94133 

Karla J. Shepard 

Program Officer 

Commonwealth Fund 

Harkness House 

One East 75th Street 

New York, New York 10021 

Hortense Canady 

National President 

Delta Sigma Theta Sorority, Inc. 

1707 New Hampshire Avenue, N.W. 

Washington, D.C. 20009 

Edward J. Montminy 

Regional Health Administrator, 

Region I 
Department of Health and 

Human Services 
Room 1400 

John F. Kennedy Federal Building 
Government Center 
Boston, Massachusetts 02203 



390 



T. Leon Nicks, Ph.D 

Director 

Division of Health Services Delivery 

Public Health Service , Region I 

Department of Health and Human 

Services 
Room 1401 

John F. Kennedy Federal Building 
Government Center 
Boston, Massachusetts 02203 

Sushma Palmer 

Executive Director 

Food and Nutrition Board 

2101 Constitution Avenue, N.W. 

Washington, D.C. 20418 

Sister Sophie 

Greater Chinatown Community 

Association 
105 Mosco Street 
New York, New York 10013 



Paul S. Jellinek 

Program Officer 

Robert Wood Johnson Foundation 

P.O. Box 2316 

Princeton, New Jersey 08540 

Nancy Mann 

Vice President 

Juvenile Diabetes Foundation, 

New York Chapter 
60 Madison Avenue, Executive Office 
New York, New York 10010 

Yosh Watanabe 

Little Tokyo Service Center 

244 South San Pedro 

Los Angeles, California 90012 

Jean Cruz 

MANA 

6020 Harmony Lane, N.W. 

Albuquerque, New Mexico 87107 



Daniel Callahan 

Director 

Hastings Center 

360 Broadway 

Hastings on Hudson, New York 10522 

George E. Casey, M.D. 

Managing Physician 

IBM Corporation 

413-122 

5600 Cottle Road 

San Jose, California 95193 

Dr. J. E. Jones 

Grand Medical Director 

Improved Benevolent Protective 

Order of Elks of the World 
P.O. Box 159 
Winton, North Carolina 27986 

Loi Kim Le 

Director 

Indochinese Refugee Assistance 

Program 
P.O. Box 355 
Santa Ana, California 92702 



Bailus Walker, Jr., Ph.D., M.P.H. 

Commissioner 

Massachusetts Department of Public 

Health 
150 Tremont Street 
Boston, Massachusetts 02111 

Cheryl Birchette Pierce, M.D. 

Medical Department, Health Services 

Massachusetts Institute of Technology 

Room 23-209 

25 Carleton Street 

Cambridge, Massachusetts 02137 

David Satcher, M.D. , Ph.D. 

President 

Meharry Medical College 

School of Medicine 
1005 Dr. D. B. Todd, Jr. Boulevard 
Nashville, Tennessee 37208 

J. Kellum Smith, Jr. 

Vice President and Secretary 

Andrew W. Mellon Foundation 

140 East 62nd Street 

New York, New York 10021 



391 



Philip M. Smith 

Executive Officer 

National Academy of Sciences 

2101 Constitution Avenue, N.W. 

Washington, D.C. 20418 

Robert L. White, Ph.D. 

President 

National Alliance of Postal 

and Federal Employees 
1628 11th Street, N.W. 
Washington, D.C. 20001 

Glendale Wiggins 

Program Specialist 

National Association of Area 

Agencies on Aging 
West Wing 208 
600 Maryland Avenue, S.W. 
Washington, D.C. 20024 

Paul Sanders, M.S.W. , M.P.H. 

Chairman 

Health Committee 

National Association of 

Black Social Workers 
P.O. Box 8123 
St. Louis, Missouri 63156 

Ada White 
President 
National Association of Community 

Health Representatives, Inc. 
P.O. Box 201 
Crow Agency, Montana 59022 

M. Phyllis Hill 

Cochairperson 

Health Task Force 

National Association of Negro 

Business and Professional 

Women's Clubs 
1806 New Hampshire Avenue, N.W. 
Washington, D.C. 20009 

Mark Battle 
Executive Director 
National Association of 

Social Workers 
2660 Woodley Road, N.W. 
Washington, D.C. 20008 



Suzan Shown Harjo 

Executive Director 

National Congress of American Indians 

804 D Street, N.E. 

Washington, D.C. 20002 

Alvin A. Walker, D.D.S. 

President 

National Dental Association 

Suite 24-25 

5506 Connecticut Avenue, N.W. 

Washington, D.C. 20015 

Raymond C. Scheppach 
Executive Director 
National Governor's Association 
444 North Capitol Street 
Washington, D.C. 20001 

Norma Rivera 

Program Director 

Asian-Pacific, Native American, Black, 

and Hispanic American Program 
National Health Screening Council 

for Volunteer Organizations, Inc. 
9411 Connecticut Avenue 
Kensington, Maryland 20895 

Juan Paz 

National Hispanic Council 

on Aging 
2713 Ontario Road, N.W. 
Washington, D.C. 20009 

Philip M. Smith, M.D. 

President 

National Medical Association 

P.O. Box 2248 

Inglewood, California 90305 

William A. Darity, Ph.D. 
National Urban League 
500 East 62nd Street 
New York, New York 10021 

Josie Candelaria 

New Mexico Health Systems Agency 

Suite 4A 

120 Vassar, S.E. 

Albuquerque, New Mexico 87106 



392 



Bernard Davidow, Ph.D. 

New York City Department of 

Health Services 
455 First Avenue 
New York, New York 10016 

S. Andrew Chen, Ph.D. 

President 

Organization of Chinese Americans 

2025 I Street, N.W. 

Washington, D.C. 20006 

Gerald J. Mossinghoff 

President 

Pharmaceutical Manufacturers 

Association 
1100 15th Street, N.W. 
Washington, D.C. 20005. 

Faye Wat tie ton 

President 

Planned Parenthood 

810 Seventh Avenue 

New York, New York 10019 

Robert D. Aranosian, D.O. , 

F.A.C.O.E.P 
President 

Michigan Chapter, A.C.E.P. 
Pontiac Osteopathic Hospital 
50 North Perry Street 
Pontiac, Michigan 48058 



Alice Dufresne, R.N. 

Clinic Coordinator RHSP 

Health Department 

Refugee Health Services Program 

976 Lenzen Avenue 

San Jose, California 95126 

Catherine J. Lenix Hooker 

Assistant Chief 

Schomburg Center for Research 

in Black Culture 
New York Public Library 
515 Lenox Avenue 
New York, New York 10037 

Regista V. Perry, Ph.D. 
Sigma Gamma Rho Sorority, Inc. 
840 East 87th Street 
Chicago, Illinois 60619 

Mabel Jung 

Director 

South of Market Mental Health 

Clinic 
428 Jessie 
San Francisco, California 94116 

T. C. Hsu 

President 

Starr Foundation 

70 Pine Street 

New York, New York 10270 



Peter Nakamura, M.D. , M.P.H. 

Deputy Director 

Chief Medical Officer 

Portland Area Indian Health Service 

1220 Southwest Third Avenue, #476 

Portland, Oregon 97204 

Angela Glover Blackwell 

Office Administrator 

Public Advocates 

1535 Mission Street 

San Francisco, California 94103 

Harold O'Flaheron 
Maternal and Child Health 

Program 
Public Health Service 
Room 6-14 
5600 Fishers Lane 
Rockville, Maryland 20857 



Christopher F. Edley 

President 

United Negro College Fund 

500 East 62nd Street 

New York, New York 10021 

Deborah Lamm 

United States Conference 

of Mayors 
1620 I Street, N.W. 
Washington, D.C. 20006 

Lee D. Stauffer 
University of Minnesota 

School of Public Health 
Mayo Hospital, Box 197 
420 Delaware Street, S.E. 
Minneapolis, Minnesota 55455 



393 



C. Arden Miller, M.D. 
Department of Maternal 

and Child Care 
University of North Carolina 

at Chapel Hill School of 

Public Health 
Rosenau Hall, 20 1H 
Chapel Hill, North Carolina 27514 



Charlie Degan 

Executive Director 

Upper Midwest American Indian 

Center 
1113 West Broadway 
Minneapolis, Minnesota 55411 



394 



RESPONDENTS TO THE SURVEY OF THE NON-FEDERAL COMMUNITY— INDIVIDUALS 



Richard Bamberg 

Associate Dean 

School of Nursing and Allied Health 

Tuskegee Institute 

Tuskegee Institute, Alabama 36088 

Shirley Cachola, M.D. 

Director 

South of Market Health Center 

551 Minna Street 

San Francisco, California 94103 

James Carter, M.D. , Dr.P.H. 
Head of Nutrition and Nursing 

Program 
School of Public Health 
Tulane University 
1430 Tulane Avenue 
New Orleans, Louisiana 70112 

Michael Chan, M.D. 

Chinese American Physicians 

Society 
411 30th Street, #306 
Oakland, California 94609 

Terrence Chang, M.D. 
Chinese American Physicians 

Society 
389 30th Street 
Oakland, California 94609 

Danny Chin, M.D. 
South Cove Health Center 
885 Washington Street 
Boston, Massachusetts 02111 

Edward Chow, M.D. 

Chinese Hospital 

490 Post Street 

San Francisco, California 94102 

Warren M. Crosby, M.D. 
Department of Obstetrics and 

Gynecology 
University of Oklahoma 

College of Medicine 
P.O. Box 26901 
Oklahoma City, Oklahoma 73190 



David Der, M.D. 

Chinese American Physicians Society 

27212 Calaroga Avenue 

Hayward, California 94545 

Mildred K. Dixon, D.P.M. 

Podiatry 

P.O. Box 753 

Tuskegee Institute, Alabama 36088 

Raymond Fay, M.D. 
Association of Chinese 
Community Physicians 
929 Clay Street 
San Francisco, California 94108 

Israel Finestone, M.D. 

Acting Director 

Department of Health Services 

L.B.J. Tropical Medical Center 

Pago Pago, American Samoa 96799 

Thomas W. Georges 
Howard University Medical School 
Johnson Administration Building 
2400 Sixth Street, N.W. 
Washington, D.C. 20059 

Steven L. Gortmaker, Ph.D. 
Department of Behavioral Sciences 
Harvard School of Public Health 
677 Huntington Avenue 
Boston, Massachusetts 02115 

Kathryn E . Gray 

Project Director 

Tulane University 

1430 Tulane Avenue 

New Orleans, Louisiana 70112 

Dr. Ernest Harburg 
University of Michigan 

School of Public Health 
109 South Observatory Street 
Ann Arbor, Michigan 48109 

Maxine Hayes, M.D. 
2915 North State Street 
Jackson, Mississippi 39216 



395 



M. Alfred Haynes , M.D. 

President and Dean 

Charles R. Drew Postgraduate 

Medical School 
1621 East 120th Street 
Los Angeles, California 90059 

Henry C. Heins , Jr., M.D., M.P.H. 
Department of Obstetrics and 

Gynecology 
Medical University of South 

Carolina 
171 Ashley Avenue 
Charleston, South Carolina 29403 

Howard H. Hiatt 

Dean 

Harvard University 

School of Public Health 
677 Huntington Avenue 
Boston, Massachusetts 02155 

Thomas W. Hubbard, M.D. , M.P.H. 
Department of Pediatrics 
Eastern Virginia Medical 

Authority 
P.O. Box 1980 
Norfolk, Virginia 23510 

James C. Hunt, M.D., M.S. 

Chancellor 

University of Tennessee 

Center of Health Sciences 
316 Hyman Administration Building 
62 South Dunlap 
Memphis, Tennessee 38163 

Norge Jerome, Ph.D. 
Professor 

University of Kansas 
School of Medicine 
Medical Center 

39th Street and Rainbow Boulevard 
Kansas City, Kansas 66103 

Ching Tai Byron Kao, M.D. 
American Center for Chinese 

Medical Science 
Gum Spring Hollow 
Brunswick, Maryland 21716 



Thomas King, M.D. 
American Chinese Medical 

Society 
445 East 68th Street 
New York, New York 10021 

Wayne Kong , Ph . D . 
Urban Cardiology Research Center 
924 West North Avenue 
Baltimore, Maryland 21217 

William Liu, Ph.D. 
Director 
Pacific/Asian Mental 

Health Research Center 
University of Illinois 

at Chicago 
1001 West Van Buren Street 
Chicago, Illinois 60607 

Rebecca W. Rimel 

Assistant Vice President 

J. Howard Pew Freedom Trust 

c/o Glenmede Trust Company 

229 South 18th Street 

Philadelphia, Pennsylvania 19103 

Shirley Roach 

Executive Assistant to the Dean 

University of California at 

Berkeley School of Public Health 
19 Earl Warren Hall 
Berkeley, California 94720 

Dennis Rodriguez 

Director 

Department of Health and 

Social Services 
Government of Guam 
P.O. Box 2816 
Agana, Guam 96910 

Winona E. Rubin, CEO 

ALU LIKE, Inc. 

Third Floor 

401 Kamakee Street 

Honolulu, Hawaii 96814 



396 



Patrick J. Sweeney, M.D., M.P.H. 
Department of Obstetrics and 

Gynecology 
University of Tennessee 

College of Medicine 
800 Madison Avenue 
Memphis, Tennessee 38163 



Elaine G. Gaines Williams, Ph.D. 
Clinical Nutrition Instructor 
Charles R. Drew Postgraduate 

Medical Shoool 
1621 East 120th Street 
Los Angeles, California 90059 



R.D. 



Richard Warnecke, Ph.D. 

President 

Illinois Cancer Council 

36 South Wabash Avenue 

Chicago, Illinois 60603 



*U.S. GOVERNMENT PRINTING OFFICE: 1986-621-604:00172 



397